Continuous Intra-intestinal Infusion of Levodopa/Carbidopa in Advanced Parkingson's Disease

the aim of most pharmacotherapy for Parkinson’s disease (PD). The theoretical background to CDS is that the physiological striatal dopaminergic stimulation is constant and that oral therapy with levodopa in PD can replace dopaminergic stimulation only in an intermittent, non-physiological manner.1,2 This pulsatile stimulation of the dopamine receptors is thought to contribute to the development of motor fluctuations, which are common after a few years of levodopa treatment and may substantially affect quality of life.3,4 Oral levodopa is highly effective but cannot be delivered in a controlled way because of its short plasma half-life and its erratic absorption due to slowed gastric emptying.5 Dopamine agonists for oral administration have longer plasma half-lives than levodopa, thereby causing less pulsatile stimulation. However, the efficacy of the agonists is only partial compared with levodopa, and side effects are more common. Levodopa is therefore almost always needed in advanced PD.