Strategic management of infusional therapies in Parkinson's disease: impact on motor and non-motor symptoms

Background: The management of advanced Parkinson's disease (PD) is often complicated by the failure of conventional oral therapies to provide sustained symptom control. PD patients progressively develop debilitating motor fluctuations and "OFF" periods, alongside long-term treatment complications which severely impact functional autonomy. Advanced PD is also characterized by a heavy burden of non-motor symptoms (NMS), including neuropsychiatric features, sleep disturbances, and autonomic dysfunction. These NMS are often underestimated but profoundly impact overall well-being. Strategic management of these patients can be improved by the administration of infusion therapies which represent a critical advancement in addressing these challenges. In this scenario, continuous delivery of levodopa-carbidopa intestinal gel (enteral), subcutaneous foslevodopa/foscarbidopa and apomorphine (subcutaneous) may be useful to achieve a more stable and continuous pharmacokinetic profile compared to pulsatile oral dosing. Strategic administration of infusion therapies represents a major advancement in addressing these challenges.

Objective: To describe the primary impact of this strategy in the significant reduction not only on motor fluctuations but also on non-motor fluctuations.

Discussion: PD infusion therapies are related to the concept of continuous dopaminergic stimulation and dramatically are able not only to reduce motor "OFF" time and duration of dyskinesias but also to significantly improve non-motor fluctuations, restoring functional independence and enhancing patients' quality of life. In fact, the efficacy of infusion therapy extends beyond motor control. Its strategic management is fundamentally reliant on a comprehensive, multidisciplinary care model. This team-based approach allows for intensive monitoring during dose titration and long-term follow-up, enabling the active identification and treatment of NMS.

Conclusions: Tailored infusion PD treatments represent a cornerstone of advanced PD care. Its success is optimized when embedded within a strategic, multidisciplinary framework that utilizes advanced monitoring to concurrently manage both motor and non-motor symptoms, leading to superior clinical outcomes.