World Congress on Controversies in Neurology – Berlin, September 2007
17 December 2007
The First World Congress on Controversies in Neurology was held in the beautiful and historically remarkable city of Berlin in September 2007. Its purpose was to encourage reasoned debate amongst practising physicians and researchers surrounding the many controversial issues emerging in neurology, with the aim of crystallising them into practical clinical conclusions.
Despite recent significant innovation, the therapy of advanced Parkinson's Disease (PD) remains one of the most-challenging demands in neurology. Pharmacotherapy designed to alleviate the symptoms of PD is focused on the stimulation of striatal dopamine receptors. Yet controversy surrounds the highly complex therapeutic scenario of advanced PD, as demonstrated during a workshop dedicated to advanced PD. Parkinson's International News highlights these controversies and brings important updates on Deep Brain Stimulation (DBS), spheramine cell therapy and the clinical progress made through the use of Continuous Dopaminergic Stimulation (CDS).
In one session, Dr Truong (USA) remembered that the unique delivery system of DUODOPA® involves a portable programmable pump that allows both the physician and patient to individually tune the delivery of active ingredients. Infusion of levodopa can be set to 20 – 200 mg/h and the patient can self-administer extra doses as needed. Unlike DBS, DUODOPA also has the advantage of enabling a brief test period to determine response to treatment and patient acceptability prior to permanent ongoing treatment.
DUODOPA provides smooth and constant plasma levodopa levels, more continuous dopaminergic stimulation and effective treatment of motor complications through physiologic-like activation of dopamine receptors. Pharmacokinetic studies demonstrate that reduced motor complications are associated with avoiding low plasma levodopa trough levels and are not adversely affected by relatively high plasma levodopa concentrations.The virtual disappearance of motor fluctuations translates into more continuous and predictable benefits for patients from levodopa therapy.
There are currently over 500 patients receiving DUODOPA therapy in Europe.
In view of the equivalent efficacy between continuous dopaminergic stimulation (CDS) and DBS, the comparatively higher risks (of neuropsychiatric problems, irreversible and severe side effects and mortality), and the more intensive management planning associated with DBS it is clear that serious consideration should be given to therapy with CDS before DBS. Dopaminergic infusions can easily be tried for a few days to test its efficacy and patient acceptability.
Spheramine (E Reissig, Germany) is currently being investigated in the STEPS Phase IIb trial, a multi-centre, double-blind, sham-surgery controlled study for the evaluation of safety, tolerability and efficacy of Spheramine implanted bilaterally into the postcommissural putamen of patients with PD. To date, 68 patients in Hoehn and Yahr stages 3 and 4 have been randomly assigned to receive intracranial injection of the cells or shamsurgery in a ratio of 1:1. A Phase III trial of Spheramine is planned for 2009.
