Abstract
Treatment of fluctuating symptoms in advanced Parkinson's disease remains a challenge. The aim of such therapies is to deliver continuous dopamine levels to prevent the aberrant, pulsatile stimulation of striatal dopamine receptors that causes wearing off and dyskinesia. Neuromodulation using deep brain stimulation can be very effective, but only for carefully selected candidates. Lower risk, device-assisted options include subcutaneous infusion of apomorphine1 and levodopa-carbidopa intestinal gel.
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