I'd like to discuss intestinal delivery systems, e.g. Duodopa, within the context of high frequency dosing.

It seems to me that both have the same objective: reduce fluctuating levodopa levels

As I see it, intestinal delivery systems have two advantages:
- continuous delivery, taking very high frequency to the limit;
- more rapid response, being downstream changes to the dose are effective more rapidly.

The major disadvantages are the need for surgical intervention, the current unavailability for some of us, and cost.

Intestinal delivery systems are intended for people for whom current medication gives poor control over their Parkinson's symptoms. It would be interesting to know how many people who are keen on going down the intestinal pump route, are currently not optimally medicated. I suspect that many would no longer want the surgery if they were optimally medicated using existing techniques.

John