EAN 2026 | Treatment advances in motor symptom management from early to advanced stage Parkinson’s disease
Carlo Colosimo, MD, FEAN, Sapienza University of Rome, Rome, Italy, discusses how the management of motor symptoms evolves as Parkinson’s disease progresses from the early to advanced stages. Prof. Colosimo highlights the introduction of COMT inhibitors and the extended-release levodopa formulation, IPX203, for early and mid-stage patients, as well as new infusion treatments and advancements in deep brain stimulation (DBS) and MR-guided focused ultrasound for advanced patients. This interview took place at the 12th Congress of the European Academy of Neurology (EAN) in Geneva, Switzerland.
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Transcript
I think in answering this question we have to divide people still in the early phase or in the mid stage in which I would say the major advancement has been the introduction of quite effective COMT inhibitors for people developing fluctuations from the beginning of fluctuation, opicapone, which has been a nice addition to what already we had, apart from levodopa, dopamine agonist, and MAO-B inhibitors, and so on...
I think in answering this question we have to divide people still in the early phase or in the mid stage in which I would say the major advancement has been the introduction of quite effective COMT inhibitors for people developing fluctuations from the beginning of fluctuation, opicapone, which has been a nice addition to what already we had, apart from levodopa, dopamine agonist, and MAO-B inhibitors, and so on. And secondly, I think a nice addition for people in this mid-stage developing early fluctuations will be this new IPX extended release formulation of levodopa, which has been already marketed in the US and is coming very soon also in Europe, which will allow a more stable level of levodopa in the plasma and because of that will allow a better control of motor fluctuations at least when motor fluctuations will start. So I think this is for the early and mid-stage Parkinson’s disease. Obviously for the advanced Parkinson’s disease patient we have a lot of new possible treatments going from infusions and a nice addition from what we had before we had already subcutaneous apomorphine we had already intraduodenal duodopa but recently we had the addition of subcutaneous foslevodopa, foscarbidopa, which works well. It’s much less invasive than the previous duodopa because you simply need to have a subcutaneous continuous infusion. It’s usually quite well tolerated and the results are quite interesting. And obviously for the patient in such an advanced stage of the disease, it’s quite an advantage to be proposed a subcutaneous infusion instead of intrajejunal infusion. And then going to surgery, we have more and more advancements in the field of DBS, directional leads, new techniques for surgery, frameless, adaptive DBS. We heard today about advancements in this field which can improve the already very good results obtained with DBS. But then, in the last few years, we had also an increasing role for MR-guided focused ultrasound, which is an incision-less technique, so apparently less invasive than DBS, but able to obtain, probably in selected patients, similar results. So much more acceptable for patients, and especially for people having a very asymmetric disease using only on one side focus ultrasound is a good alternative to DBS and much more acceptable to patients.
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