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Therapeutic Strategies to Treat or Prevent Off Episodes in Adults with Parkinson’s Disease

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Abstract

Parkinson’s disease is a chronic, neurodegenerative disease, which manifests with a mixture of motor, cognitive and behavioural symptoms. Levodopa is the most effective antiparkinsonian treatment to date, although chronic use engenders a mixture of complications in a substantial proportion of patients. Amongst these is the occurrence of episodes of worsening symptoms—‘off’ phenomena. These episodes can manifest with either motor or non-motor symptoms or a combination of these features and have been found to have profound impacts on patients’ quality of life. Although preventative measures are poorly evidenced, avoiding excessive total daily levodopa intake in selected populations that are deemed to be of a higher risk for develo** these episodes warrants further exploration. Methods to improve levodopa bioavailability and delivery to the brain are currently available and are of value in addressing these episodes once they have become established. These include modifications to levodopa formulations as well as the use of complimentary agents that improve levodopa bioavailability. The deployment of device-assisted approaches is a further dimension that can be considered in addressing these debilitating episodes. This review summarises the clinical manifestations of ‘off’ phenomena and the current approaches to treat them. Although we briefly discuss clinical advances on the horizon, the predominant focus is on existing, established treatments.

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Authors and Affiliations

  1. Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London, UK

    Nirosen Vijiaratnam & Thomas Foltynie

  2. The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK

    Nirosen Vijiaratnam & Thomas Foltynie

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  1. Nirosen Vijiaratnam
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Correspondence to Thomas Foltynie.

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Funding

NV’s research time and position is funded by the Janet Owens charitable foundation. No funding was received specifically for this review.

Conflict of interest

NV has received educational support from Abbvie, Stada, Ipsen and Merc, speaker’s honorarium from Abbvie & Stada and served on advisory boards for Abbvie & Britannia Pharmaceuticals. TF has received grant support form Cure Parkinson’s trust, Michael J Fox Foundation, John Black Charitable Foundation, Van Andel Institute, Defeat MSA, Innovate UK, National Institute for Health Research. He has received honoraria for speaking at meetings sponsored by Bial, Profile Pharma, Britannia and Boston Scientific. He has served on advisory boards for Living Cell Technologies, Voyager Therapeutics and Oxford Biomedica.

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Vijiaratnam, N., Foltynie, T. Therapeutic Strategies to Treat or Prevent Off Episodes in Adults with Parkinson’s Disease. Drugs 80, 775–796 (2020). https://doi.org/10.1007/s40265-020-01310-2

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