Therapy of late motor complications in advanced Parkinson's disease

A contribution by Jürgen Zender


Optimized Therapy late motor complications in advanced Parkinson's disease

The therapy of movement disorders in the advanced stage of idiopathic parkinsonian syndrome represents a challenge, as optimizing dopamine treatment does not always bring the expected results. It is therefore crucial to consider more intensive treatment approaches in a timely manner. As soon as signs of an advanced stage become apparent, physicians should immediately provide information about suitable therapy options and familiarize patients with possible treatment options.

A recent article published in Neurotransmitter on August 6, 2023 sheds light on treatment optimization in patients with advanced idiopathic parkinsonian syndrome. For those unfamiliar with medical jargon, here is a simpler overview of the key points:

Late motor complications: These are challenges that Parkinson's patients face in the later stages of the disease. These include movement disorders, uncontrolled movements and muscle spasms, which can significantly impair the quality of life.

Cause: One of the reasons why these complications occur is the way the body absorbs the drug L-Dopa. The amount of the drug in the blood fluctuates, which can lead to these movement problems.

oral therapy options

L-dopa: This is the main drug used to treat Parkinson's disease. It has a short duration of action, so patients in advanced stages need to take it more frequently. New formulations, including an inhalable version, could help patients better control movement symptoms.

COMT inhibitors: These medications help prolong the effects of L-dopa in the body. Opicapone is particularly interesting here because it can be taken once at night and could help Pain in Parkinson's patients.

MAO-B inhibitors: Three of these drugs are currently approved. They help the effect of dopamine, an important neurotransmitter, and can also relieve pain in Parkinson's patients.

amantadine: A longer known drug that helps control movement problems and is well tolerated by patients.

Dopamine agonists: These drugs mimic the action of dopamine in the brain. There have been some concerns about their side effects, but they can be useful in all stages of the disease.

The article emphasizes that the therapeutic approaches can differ individually depending on the patient and the course of the disease. It is important that people work closely with their doctors to develop the best treatment plan and to maintain the quality of life as much as possible.

Intensified therapies: what and when?

Parkinson's disease, often abbreviated as PD, can progress over time and require the need for more intensive treatments. The intensified therapy options include the apomorphine and L-Dopa pumps as well as the DBS procedure. Once patients enter the advanced stage of the disease, these therapeutic options should be seriously considered. Interestingly, the transition to advanced disease is not well defined, which can make it difficult to determine the ideal timing for these therapeutic options. There are also differences in the preference for these forms of therapy internationally, possibly due to cost considerations.

L-Dopa pump therapies: The “5-2-1” rule

When considering whether to consider L-Dopa pump therapy, there are three main criteria known as the "5-2-1" rule. This includes:

– “5”: Taking five or more L-Dopa tablets per day.

– “2”: off-phases that last at least two hours a day.

– “1”: Disabling dyskinesia lasting an hour or more daily.

If a patient meets one of these criteria, intensified therapy could be a possible treatment option.

New pump systems

Two main pump systems are currently available, the Duodopa® pump and the Lecigon® pump. Both provide continuous dopamine stimulation and can improve patient mobility throughout the day. The main goal is to provide patients with a better quality of life.

The future of therapy

There are exciting developments in the world of Parkinson's therapies. A new method of administering L-Dopa subcutaneously is on the way, and early studies are showing promising results. Subcutaneous administration of apomorphine, a dopamine agonist, has also shown beneficial effects.


There are many advanced therapy options for people with Parkinson's disease, and finding the best time to start these therapies is critical. With the right information and communication between doctor and patient, those affected can find treatment that significantly improves their quality of life.

Stay tuned.


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