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Considerations for the Maintenance of ON Time in Parkinson Disease - Episode 1

Role of Levodopa in Managing Parkinson Disease

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Rajesh Pahwa, MD, reviews the use of levodopa for the management of Parkinson disease symptoms.

Stuart Isaacson, MD: Hello and welcome to this NeurologyLive® Peer Exchange titled, “Considerations for the Maintenance of ON Time in Parkinson Disease.” I am Dr Stuart Isaacson, an associate professor of neurology at the Florida International University Herbert Wertheim College of Medicine and the director of the Parkinson’s Disease and Movement Disorders Center of Boca Raton, in Florida. Joining me today in this discussion are my colleagues: Dr Rajesh Pahwa, professor of neurology and the director of the Parkinson’s Disease and Movement Disorder Center, from the University of Kansas Medical Center in Kansas City, Kansas; and Dr Laxman Bahroo, associate professor of the Department of Neurology, and the director of both the botulinum toxin clinic and the residency program at MedStar Georgetown University Hospital in Washington, DC; and Dr Robert Hauser, a professor of neurology, molecular pharmacology, and physiology at the University of South Florida [USF] Morsani College of Medicine, and the director of the Clinical Signature Interdisciplinary Program at the USF Health Byrd Parkinson’s Disease and Movement Disorders Center in Tampa, Florida.

Welcome everyone, and let’s get started. We’re going to talk about Parkinson disease and some of the issues we face in the management of it, using levodopa, and the ultimate emergence of OFF episodes. Raj, do you want to briefly review the use of levodopa in our management of Parkinson disease symptoms?

Rajesh Pahwa, MD: Definitely. Levodopa, as you know, is a gold standard. Levodopa is the most efficacious treatment we have for Parkinson disease. It makes sense, right? In Parkinson disease, there is reduced dopamine, so when we use levodopa, it crosses the blood-brain barrier and is converted to dopamine, which is reduced in patients with Parkinson disease. Being the most efficacious medicine, once the patients are having difficulty with activities, we usually initiate levodopa. Levodopa has a marked improvement in Parkinson symptoms, whether it is tremor, bradykinesia, rigidity, or gait issues that the patient is having. A caveat to remember here is tremor only responds in about 50% of the patients as far as levodopa is concerned, and in fact despite that, levodopa still is the most effective treatment even for tremors. One of the challenges that we’ll discuss later is what happens with the long-term treatment of Parkinson disease with levodopa, which is motor fluctuations and dyskinesias.

Transcript Edited for Clarity