Videos

2 experts are featured in this series.

Panelists discuss how treatment decisions for complex cases like the 66-year-old man with severe dyskinesia and 4 hours of daily “off” time require individualized approaches based on patient tolerance, with options including delayed-release/extended-release amantadine (starting at lower doses in older patients due to hallucination risk), extended-release carbidopa-levodopa formulations, infusion pumps for potential deep priming effects, or deep brain stimulation for patients seeking rapid improvement, emphasizing the importance of engaging patients in discussions about their patience for dose adjustments, risk tolerance for adverse effects, and desired timeline for symptom control to guide optimal treatment selection.

2 experts are featured in this series.

Panelists discuss how a 66-year-old man with 8 years of Parkinson disease presenting with severe peak-dose dyskinesia affecting basic functions like eating and speaking, plus 4 hours of daily “off” time despite frequent dosing, represents a patient who should not have been allowed to progress to such advanced motor complications, emphasizing that the preferred approach is early intervention to treat motor fluctuations and dyskinesia as they develop rather than waiting until patients reach this severely impaired state with complex symptoms requiring more intensive management strategies.

2 experts are featured in this series.

Panelists discuss how treatment options for advanced Parkinson disease patients like the 54-year-old woman include deep brain stimulation (DBS) as an excellent choice given her young age and cognitive status, with amantadine delayed-release/extended-release showing robust effects comparable to DBS (about 3 hours of increased good “on” time) in patients meeting DBS criteria, while newer infusion therapies may offer potential benefits through both pharmacokinetic effects from reducing peak-trough levels and a theoretical "deep priming" process that could reset hypersensitive dopamine receptors by providing continuous stimulation, though more research data is needed to confirm these hypothetical benefits.

2 experts are featured in this series.

Panelists discuss how delayed-release/extended-release amantadine represents a unique treatment option for patients like the 54-year-old woman with both dyskinesia and “off” time, as it is the only FDA-approved medication that addresses both conditions simultaneously, with its bedtime dosing and pharmacokinetic profile providing overnight absorption and sustained daytime levels that resulted in phase 3 trials showing a 40% reduction in dyskinesia and 2.4 hours of increased good “on” time, making it an ideal first-line treatment for patients who have both troublesome dyskinesia and motor fluctuations rather than simply reducing dopaminergic medications which would worsen motor symptoms.