Movement Disorders, Parkinson's Disease
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Beyond Motor Symptoms – Impact of Continuous Dopaminergic Stimulation on Non-motor and Social Aspects of Advanced Parkinson’s Disease

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Published Online: Jul 15th 2012 European Neurological Review, 2012;7(Suppl. 1):17–9 DOI:
Authors: Barbara Pickut
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Two patient cases are presented here that illustrate the benefits of continuous dopaminergic stimulation on the non-motor symptoms of Parkinson’s disease. In both cases, levodopa/carbidopa intestinal gel infusion therapy led to improvements in anxiety, depression, concentration, urge incontinence, sexual function, sleep, vivid dreams and rapid eye movement sleep behaviour disorder, pain, sweating and feelings of self-assuredness. Such improvements have an impact on patients’ quality of life and can help their social functioning.


Parkinson’s disease, levodopa, continuous dopaminergic stimulation, non-motor symptoms, quality of life


The non-motor symptoms (NMS) of Parkinson’s disease (PD) are common and often not fully appreciated. They are sometimes referred to as non-dopaminergic symptoms, which in some cases may be a misnomer. NMS are present at all stages of the disease, and are potentially a major source of disability. Some of these symptoms, such as dementia, delirium, hallucinations, and psychosis, are important factors in PD patients’ lives and may lead to institutionalisation. As such, they affect not only the individual but also have a social impact.

It is encouraging that the non-motor features of PD have been incorporated into the American Academy of Neurology (AAN) PD quality measures published in 2010,1 as healthcare stakeholders use these measures when making decisions on the allocation of healthcare resources. Out of the 10 AAN quality measures, five concern the non-motor features of PD (see Box 1).

The following two case reports illustrate the impact of continuous dopaminergic stimulation (CDS) on the NMS and social aspects of PD.

Case Report 1
Patient 1, a 57-year-old male family physician, had been diagnosed with PD at the age of 45. After 12 years of PD, his daily regimen was 800 mg levodopa (spread over seven intakes) plus 100 mg levodopa-benserazide hydrodynamically balanced system (HBS). He also took 200 mg tolcapone (three times a day), 100 mg amantadine (twice daily), 1 mg rasagiline (once daily) and 150 mg venlafaxine (once daily).

The patient’s motor complications included troublesome dyskinesias, end-of-dose ‘wearing off’, unpredictable ‘on-off’ motor fluctuations, dose failures and delayed ‘on’. His non-motor complications comprised depression, free-floating anxiety, concentration problems, sleep dysfunction, autonomic dysfunction (urinary urgency), sensory dysfunction (hyposmia and pain) and sexual dysfunction (erectile dysfunction and libido loss). The patient’s family was concerned that he might become dyskinetic or drop into a deep ‘off’ when he was outside the home. The NMS were also very troublesome for the patient professionally, with his patients beginning to question his competency. The combination of motor and non-motor complications led him to a forced early retirement and the patient’s social and family life were adversely affected.

To obtain reimbursement from the Belgian authorities for levodopa/carbidopa intestinal gel (LCIG) infusion, a test week is required. The patient completed a test week in November 2009, and in March 2010 approval was obtained to initiate LCIG infusion therapy. All other Parkinson’s medications were stopped. Hisdosages during the first year of LCIG infusion therapy were fairly stable (see Table 1).

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Article Information:

Barbara Pickut serves on advisory boards for Boehringer Ingelheim, GlaxoSmithKline, Abbott (Solvay) Pharmaceuticals and UCB, and has received research grants from Boehringer Ingelheim.


Barbara Pickut, University Hospital Antwerp (UZA), Department of Neurology, Wilrijkstraat 10, 2650 Edegem, Belgium. E:


The V International Forum on Parkinson’s Disease (Helsinki, Finland, 6–7 May 2011) was funded by an unrestricted educational grant from Abbott. Abbott funded the development of this supplement by ESP Bioscience (Crowthorne, UK). Emily Chu and Nicole Meinel of ESP Bioscience provided medical writing and editorial support to the author in the development of this publication. Abbott had the opportunity to review and comment on the publication’s content; however, all decisions regarding content were made by the author.




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