Continuous dopaminergic stimulation: Is it the answer to the motor complications of Levodopa?


  • John G. Nutt MD

    Corresponding author
    1. Northwest PADRECC, Portland VAMC, and Parkinson Center of Oregon, Oregon Health & Science University, Portland, Oregon, USA
    • Oregon Health & Science University, Portland VAMC Northwest PADRECC, Oregon Health & Science University, Parkinson Center of Oregon, 3181 SW Sam Jackson Park Road, OP32, Portland, OR 97239-3098
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Continuous dopaminergic stimulation (CDS) is a treatment strategy hypothesized to avoid or reduce the motor complications of long-term levodopa therapy, motor fluctuations, and dyskinesia, by preventing or reversing sensitization induced by pulsatile dopaminergic stimulation. The CDS hypothesis is itself based on several hypotheses. First, tonic dopaminergic stimulation is physiological. Second, sensitization is undesirable and should be reversed. Third, reduction of off time and dyskinesia can be induced simultaneously. Finally, clinical studies substantiate the CDS hypothesis. The evidence for these hypotheses is reviewed, and the need for randomized clinical trials that rigorously test the CDS hypothesis is emphasized. © 2006 Movement Disorder Society