A case of monotherapy with intracerebroventricular anaerobic dopamine allows complete control of Parkinson's disease symptoms

Plain language summary Continuous intracerebroventricular administration of anaerobic dopamine represents a potential new device-aided therapy option for Parkinson's disease with L-dopa-related complications. A-dopamine is administered via a telemetry-controlled subcutaneous abdominal pump connected to a catheter implanted in the ventricle, near the striatum. We present the case of one patient with A-dopamine as monotherapy. Continuous intracerebroventricular administration of anaerobic dopamine (A-dopamine) represents a potential new device-aided therapy option for Parkinson's disease in the stage of severe L-dopa-related complications. A-dopamine is administered via a telemetry-controlled subcutaneous abdominal pump connected to a catheter implanted in the ventricle, near the striatum. We previously demonstrated its value as an add-on therapy in a Phase I/II trial, which showed a 4.4-hour increase in the duration of perfect control without “off” episodes or dyskinesia, and a 6.2-hour increase in the duration of good autonomy, compared to the best oral treatment with a 60% reduction in oral L-dopa. We present here the case of one such patient who benefited from long-term administration of A-dopamine as monotherapy, as the sole treatment. A dose of 240 mg of A-dopamine during the day and 40 mg at night allowed for complete control of motor symptoms without any dyskinesia, painful dystonia, fluctuations, or mental agitation, and without any oral medication. Monotherapy with A-dopamine produced greater benefits than those of adjunctive therapy added to optimized oral treatment. It is interesting to note that A-dopamine and L-dopa had a different clinical effect, since no dyskinesia or psychic excitation was observed with A-dopamine, unlike with L-dopa.