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PD – Continuous Dopaminergic Stimulation — SCE Neurology MCQ

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HardMovement DisordersPD – Continuous Dopaminergic StimulationSCE Neurology

A 67-year-old with levodopa-responsive advanced Parkinson disease has disabling unpredictable off periods and dyskinesia despite optimised oral and transdermal treatment. Continuous apomorphine caused recurrent syncope, deep brain stimulation is unsuitable, and previous upper gastrointestinal surgery makes PEG-J treatment impracticable. Which remaining device-aided strategy should be considered?

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Correct answer: A — Continuous subcutaneous foslevodopa–foscarbidopa infusion over the waking day

NICE recommends considering foslevodopa–foscarbidopa for advanced levodopa-responsive Parkinson disease with severe motor fluctuations and hyperkinesia or dyskinesia when available medicines do not adequately control symptoms and apomorphine infusion or deep brain stimulation cannot be used, or no longer provides adequate control. This scenario satisfies those criteria and also makes jejunal levodopa delivery impracticable. Intermittent apomorphine does not provide equivalent continuous control and may reproduce the adverse effect, while retrying the failed infusion or unsuitable surgery does not resolve the stated constraints.

Reference: NICE NG71, Parkinson’s disease in adults — recommendations: https://www.nice.org.uk/guidance/ng71/chapter/recommendations