Get access

REVIEW

The Role of Pulsatile Versus Continuous Dopamine Receptor Stimulation for Functional Recovery in Parkinson's Disease

Authors

  • J. A. Obeso,

    Corresponding author
    1. Movement Disorders Unit and Experimental Neurology, Department of Neurology, Clínica Universitaria, University of Navarra, Apdo. 192, 31080 Pamplona, Spain
      Dr J. A. Obeso, as above
    Search for more papers by this author
  • F. Grandas,

    1. Movement Disorders Unit and Experimental Neurology, Department of Neurology, Clínica Universitaria, University of Navarra, Apdo. 192, 31080 Pamplona, Spain
    Search for more papers by this author
    • 1

      Servicio de Neurología, Hospital Gregorio Marañón, Madrid, Spain

  • M. T. Herrero,

    1. Movement Disorders Unit and Experimental Neurology, Department of Neurology, Clínica Universitaria, University of Navarra, Apdo. 192, 31080 Pamplona, Spain
    Search for more papers by this author
    • 2

      Facultad de Medicina, Universidad de Murcia, Spain

  • R. Horowski

    1. Special Research Projects, Schering AG, Berlin, Germany
    Search for more papers by this author

Dr J. A. Obeso, as above

Abstract

More effective measures to control and replace the dopaminergic deficit of Parkinson's disease are being actively sought. One basic problem is how the striatal dopamine loss should be replaced in order to mimic most accurately the physiological state. Animal electrophysiology indicates that the dopaminergic nigrostriatal pathway has a dual tonic and phasic action. Intermittent dopaminergic stimulation is associated with behavioural hyposensitivity both in animal models and in patients with Parkinson's disease. Continuous dopaminergic stimulation provides a tonic background and improves some clinical problems but is also associated with tolerance. None of the available pharmacological approaches can restore the dopamine deficiency of Parkinson's disease to physiological levels. Continuous dopaminergic stimulation for <24 h, associated with small doses of levodopa or a short-acting dopamine agonist, appears to be the best, albeit imperfect, therapeutic approach until other, more efficacious remedies are developed.

Get access to the full text of this article

Ancillary