Device-Aided Therapies in Advanced Parkinson's Disease
Summary
As Parkinson’s disease progresses, conventional oral medication may become inadequate to control the motor and non-motor complications that emerge in advanced stages. Device-aided therapies seek to deliver continuous dopaminergic stimulation or targeted neuromodulation in order to attenuate fluctuations in motor performance, reduce dyskinesia and improve quality of life. Three principal approaches have been established: continuous intestinal infusion of levodopa–carbidopa gel, subcutaneous infusion of apomorphine and deep brain stimulation of the subthalamic nucleus or globus pallidus interna. Each modality offers distinct advantages and limitations in terms of invasiveness, technical demands, risk profile and patient suitability. Optimising device selection requires a multidisciplinary assessment that balances motor symptom control against surgical and device-related complications, as well as consideration of non-motor symptom burden, cognitive status and caregiver support. Emerging evidence highlights the importance of individualised therapy algorithms to maximise long-term functional outcomes and reduce healthcare costs on a global scale.
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Device-Aided Therapies in Advanced Parkinson's Disease publication trend
The graph below shows the total number of articles in device-aided therapies in advanced parkinson's disease across all publications each year (not limited to Nature Index journals).
Technical terms
Advanced Parkinson’s disease (aPD): A stage of Parkinson’s marked by persistent motor fluctuations and complications unresponsive to optimised oral therapy.
Levodopa–carbidopa intestinal gel (LCIG): Continuous enteral delivery of levodopa and carbidopa via a percutaneous gastrojejunal tube to reduce plasma level fluctuations.
Continuous subcutaneous apomorphine infusion: Delivery of the dopamine agonist apomorphine via a wearable pump to provide steady dopaminergic stimulation.
Subthalamic nucleus deep brain stimulation (STN-DBS): Surgical implantation of electrodes to modulate neural activity within the subthalamic nucleus and ameliorate motor symptoms.
Motor fluctuations: Variations in mobility and symptom control during the dosing cycle of dopaminergic therapy, including unpredictable on-off phenomena.
Dyskinesia: Involuntary, hyperkinetic movements arising as a complication of long-term levodopa treatment.
Off time/On time: Periods when dopaminergic medication effects are diminished (“off”) or optimal (“on”) in relation to motor function.
References
- A single centre prospective study of three device-assisted therapies for Parkinson’s disease. npj Parkinson's Disease (2023).
- Levodopa–Entacapone–Carbidopa Intestinal Gel in the Treatment of Advanced Parkinson’s Disease: A Single Center Real-World Experience. Pharmaceutics (2024).
- Levodopa Carbidopa Intestinal Gel in Advanced Parkinson’s Disease: DUOGLOBE Final 3-Year Results. Journal of Parkinson’s Disease (2023).
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