Parkinson’s is a progressive neurodegenatuve disease and management of advanced PD is a complex affair, as the disease progress, patients will be on cocktail of oral medications, at least 20 tablets a day. Main problems with oral therapies because of delayed gastric emptying, poor gastric absorption, can cause medication overload can cause severe intestinal obstruction, life threatening Aspiration pneumonia. To avoid these on and off motor fluctuations caused by pulsatile oral medications and to achieve a straight line like this in other words continuous drug delivery, continuous dopaminergic stimulation achieved by non oral infusion therapies, like Continuous delivery of Intrajejunal Ldopa (IJLI) or S/C apomorphine administration by continuous waking day infusions/morning infusions or rescue intermittent pen injections. Apo injections provide reliable rapid ON time with in 7-10mins and can last up to 90mins, these Pen injections can be used as an adjunct to oral regime especially in those who gets predictable OFF’s ( Freezing/unable to walk) for patients with prolonged and predicted OFFs not controlled by oral medications then continuous S/C Apo infusions ( wakeful 12-17hours) recommended.
Duodopa – Nothing but traditional Ldopa (Sinemet/Syndopa) in a gel form given through PEG-J direct to Jejunum, it bypasses Stomach and Duodenum where lot of gastric enzymes, hydrochlroric acid release occurs and cause compettive inhibition breaking bioavailability of Levodopa.
It provides continuous Dopamine delivery to brain and avoids motor and non motor fluctuations. Advantages of these infusion therapies is eventually we might consider to tailor all oral medicines.
Both Infusion therapies are well tolerated by patients and few side effects like skin nodules with Apomorphine ( changing the site will avoid this) or PEG site infection with Duodopa ( again skin hygeine etc will be beneficial).
We are pioneers in these non conventional treatments and has largest data base of patients in Europe