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      The Administration of Levodopa in a Patient With Parkinson’s Disease Using a Novel Maxillofacial Route: A First-in-Human Report

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          Abstract

          Parkinson's disease is characterized by the loss of nigrostriatal dopaminergic neurons in the brain. Dopamine cannot be administered systemically because it does not cross the blood-brain barrier. Oral levodopa remains the gold standard to date. Currently, for patients who show a poor response to oral levodopa and for those who cannot take it orally, the alternate routes available are inhalation and continuous administration via intestinal and subcutaneous routes. In this report, a novel maxillofacial route was used for the first time in the world to administer levodopa to a Parkinson's patient. Furthermore, the efficacy of maxillofacial administration was compared with the oral route of administration.

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          Parkinson disease-associated cognitive impairment

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            Long term motor complications of levodopa: clinical features, mechanisms, and management strategies.

            Levodopa is the most effective symptomatic treatment of Parkinson's disease. However, after an initial period of dramatic benefit, several limitations become apparent including, "dopa resistant" motor symptoms (postural abnormalities, freezing episodes, speech impairment), "dopa resistant" non-motor signs (autonomic dysfunction, mood and cognitive impairment, etc), and/or drug related side effects (especially psychosis, motor fluctuations, and dyskinesias). Motor complications include fluctuations, dyskinesias, and dystonias. They can be very disabling and difficult to treat. Therefore, strategies should ideally be developed to prevent them. Though mechanisms underlying motor complications are only partially understood, recent work has revealed the importance of pulsatile stimulation of postsynaptic dopamine receptors and the disease severity. As a result of intermittent stimulation there occurs a cascade of changes in cell signalling leading to upregulation of the N-methyl-D-aspartate subtype of gamma-aminobutryric acid-ergic neurones. Modified preparations of levodopa (controlled release preparations, liquid levodopa), catecholamine-o-methyltransferase inhibitors, dopamine agonists, amantidine, and various neurosurgical approaches have been used in the prevention and/or treatment of motor complications. Current management of motor complications is less than satisfactory. With better understanding of the pathogenetic mechanisms, it is hoped that future therapeutic strategies will provide a safer and targeted treatment.
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              Disorders of the Oral Cavity in Parkinson's Disease and Parkinsonian Syndromes

              Awareness of nonmotor symptoms of Parkinson's disease is growing during the last decade. Among these, oral cavity disorders are, although prevalent, often neglected by the patients, their caregivers, and physicians. Some of these disorders include increased prevalence of caries and periodontal disease, sialorrhea and drooling, xerostomia, orofacial pain, bruxism, and taste impairment. Though many of these disorders are not fully understood yet and relatively few controlled trials have been published regarding their treatment, physicians should be aware of the body of evidence that does exist on these topics. This paper reviews current knowledge regarding the epidemiology, pathophysiology, and treatment options of disorders of the oral cavity in Parkinson's disease patients.
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                Author and article information

                Journal
                Cureus
                Cureus
                2168-8184
                Cureus
                Cureus (Palo Alto (CA) )
                2168-8184
                30 October 2023
                October 2023
                : 15
                : 10
                : e48011
                Affiliations
                [1 ] Neurology, Indira Gandhi Government General Hospital and Post Graduate Institute, Puducherry, IND
                [2 ] Computer Science Engineering, Puducherry Technological University, Puducherry, IND
                [3 ] General Medicine, Indira Gandhi Government General Hospital and Post Graduate Institute, Puducherry, IND
                [4 ] Research and Development, UR Anoop Research Group, Puducherry, IND
                [5 ] Orthodontics and Dentofacial Orthopaedics, UR Anoop Research Group, Puducherry, IND
                [6 ] Conservative Dentistry and Endodontics, UR Anoop Research Group, Puducherry, IND
                [7 ] Periodontics, UR Anoop Research Group, Puducherry, IND
                [8 ] Dentistry, UR Anoop Research Group, Puducherry, IND
                Author notes
                Article
                10.7759/cureus.48011
                10687491
                38034171
                ba98a5d6-d664-464b-8fd6-8dde2662aeca
                Copyright © 2023, Thirunavukarasu et al.

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 30 October 2023
                Categories
                Neurology
                Healthcare Technology
                Therapeutics

                parkinson' s disease,novel drug delivery,drug delivery system,maxillofacial route,levodopa

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