{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T03:06:04Z","timestamp":1788231964659,"version":"build-2803163510"},"reference-count":14,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2024,8,26]],"date-time":"2024-08-26T00:00:00Z","timestamp":1724630400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p>Akinetic crisis is a severe deterioration of motor performance occurring in syndromes with pre- or postsynaptic dopaminergic deficit, necessitating effective dopamine replacement therapy. The subcutaneously applicable levodopa derivative foslevodopa represents a new therapeutic option for patients with advanced Parkinson\u2019s disease as a continuous therapy. However, its potential role as a parenteral treatment option for akinetic crisis has not been investigated, yet.<\/jats:p><\/jats:sec><jats:sec><jats:title>The case<\/jats:title><jats:p>A 78\u2009year-old patient who had developed akinetic-rigid symptomatology in the context of normal pressure hydrocephalus was admitted to our intensive care unit after experiencing an acute exacerbation of akinesia in the context of pulmonary infection. Off-label administration of subcutaneous foslevodopa was initiated after repeated failures to insert a gastric tube for enteral application of levodopa and contraindications against amantadine and apomorphine.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Following the administration of a subcutaneous test dose, continuous application of foslevodopa via a B. Braun syringe pump was gradually increased to 0.3\u2009mL\/h during the daytime and 0.15\u2009mL\/h at night, corresponding to a levodopa equivalent dosage of 1,020\u2009mg\/d. This was accompanied by an improvement of the MDS-UPDRS III score from 85 points to 59 points after 72\u2009h.<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion<\/jats:title><jats:p>Treatment of an akinetic crisis with subcutaneous foslevodopa in an intensive care unit setting has proven to be safe and effective in a patient with acute akinesia associated with dopamine-sensitive hydrocephalus. Due to the pathophysiological distinction from Parkinson\u2019s disease, there may be differences in therapeutic response and side effects. Nevertheless, the method used here can serve as a protocol basis for the treatment of akinetic crises with foslevodopa in general and as a starting point for further research.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fmed.2024.1446345","type":"journal-article","created":{"date-parts":[[2024,8,26]],"date-time":"2024-08-26T04:52:31Z","timestamp":1724647951000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":9,"title":["Subcutaneous foslevodopa in akinetic crisis. A case report from the neurological intensive care unit"],"prefix":"10.3389","volume":"11","author":[{"given":"Moritz A.","family":"Loeffler","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annerose","family":"Mengel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Constanze","family":"Single","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Weiss","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katharina","family":"Feil","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2024,8,26]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"1162","DOI":"10.1212\/01.WNL.0000157058.17871.7B","article-title":"Acute akinesia in Parkinson disease","volume":"64","author":"Onofrj","year":"2005","journal-title":"Neurology"},{"key":"ref2","volume-title":"Parkinson-Krankheit, S2k-Leitlinie: Deutsche Gesellschaft f\u00fcr Neurologie (Hrsg.), Leitlinien f\u00fcr Diagnostik und Therapie in der Neurologie","author":"H\u00f6glinger","year":"2023"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"52","DOI":"10.1002\/ana.26073","article-title":"Foslevodopa\/Foscarbidopa: a new subcutaneous treatment for Parkinson's disease","volume":"90","author":"Rosebraugh","year":"2021","journal-title":"Ann Neurol"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"1099","DOI":"10.1016\/S1474-4422(22)00400-8","article-title":"Safety and efficacy of continuous subcutaneous foslevodopa-foscarbidopa in patients with advanced Parkinson's disease: a randomised, double-blind, active-controlled, phase 3 trial","volume":"21","author":"Soileau","year":"2022","journal-title":"Lancet Neurol"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"53","DOI":"10.1002\/mds.870120110","article-title":"Movement disorders in adult hydrocephalus","volume":"12","author":"Krauss","year":"1997","journal-title":"Movement Disorders Off J Movement Disorder Soc"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"803","DOI":"10.1038\/sj.jcbfm.9600389","article-title":"In vivo presynaptic and postsynaptic striatal dopamine functions in idiopathic normal pressure hydrocephalus","volume":"27","author":"Ouchi","year":"2007","journal-title":"J Cereb Blood Flow Metab"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"1981","DOI":"10.2967\/jnumed.107.045310","article-title":"Striatal D2 receptor availability after shunting in idiopathic normal pressure hydrocephalus","volume":"48","author":"Nakayama","year":"2007","journal-title":"J Nucl Med Off Publ Soc Nucl Med"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"120019","DOI":"10.1016\/j.jns.2021.120019","article-title":"Parkinsonism and cerebrospinal fluid disorders","volume":"433","author":"Youn","year":"2022","journal-title":"J Neurol Sci"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"2179","DOI":"10.1038\/npp.2013.115","article-title":"Chronic interferon-alpha decreases dopamine 2 receptor binding and striatal dopamine release in association with anhedonia-like behavior in nonhuman primates","volume":"38","author":"Felger","year":"2013","journal-title":"Neuropsychopharmacology"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"267","DOI":"10.1016\/j.expneurol.2005.04.008","article-title":"An active transport system in the blood-brain barrier may reduce levodopa availability","volume":"195","author":"Hawkins","year":"2005","journal-title":"Exp Neurol"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"15014","DOI":"10.1038\/npjparkd.2015.14","article-title":"Why is there motor deterioration in Parkinson's disease during systemic infections-a hypothetical view","volume":"1","author":"Brugger","year":"2015","journal-title":"NPJ Parkinsons Dis"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"1781","DOI":"10.1002\/mds.28632","article-title":"Dopamine receptors in Parkinson\u2019s disease: a meta-analysis of imaging studies","volume":"36","author":"Kaasinen","year":"2021","journal-title":"Mov Disord"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"1429","DOI":"10.1093\/brain\/114.3.1429","article-title":"D1\/D2 dopamine receptor stimulation by L-dopa. A [14C]-2-deoxyglucose autoradiographic study","volume":"114","author":"Trugman","year":"1991","journal-title":"Brain"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"36","DOI":"10.1136\/jnnp.2005.083113","article-title":"Neuropsychiatric symptoms in patients with Parkinson's disease and dementia: frequency, profile and associated care giver stress","volume":"78","author":"Aarsland","year":"2007","journal-title":"J Neurol Neurosurg Psychiatry"}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2024.1446345\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,8,26]],"date-time":"2024-08-26T04:52:33Z","timestamp":1724647953000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2024.1446345\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,8,26]]},"references-count":14,"alternative-id":["10.3389\/fmed.2024.1446345"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2024.1446345","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,8,26]]},"article-number":"1446345"}}