Duodenal levodopa infusion for advanced Parkinson's disease: 12‐month treatment outcome

Antonini, Angelo; Isaias, Ioannis U.; Canesi, Margherita; Zibetti, Maurizio; Mancini, Francesca; L, Manfredi; Fante, Marco Dal; Lopiano, Leonardo; Pezzoli, Gianni

doi:10.1002/mds.21500

Cited by 213 publications

(162 citation statements)

References 17 publications

Supporting

Mentioning

141

Contrasting

Unclassified

Order By: Relevance

“…Continuous jejunal infusion of levodopa/carbidopa intestinal gel (LCIG) via a percutaneous pump leads to more constant plasma levels of levodopa (Nyholm et al., 2003), and it results in significant reduction in off‐time and on‐time with troublesome dyskinesias (Antonini et al., 2007; Eggert et al., 2008; Fernandez et al., 2013; Olanow et al., 2014). Common side effects of LCIG treatment are surgical‐ or device‐related complications (Olanow et al., 2014), but there are also anecdotal reports on neuropathy in LCIG‐treated patients.…”

Section: Introductionmentioning

confidence: 99%

Effects of levodopa/carbidopa intestinal gel versus oral levodopa/carbidopa on B vitamin levels and neuropathy

et al. 2017

View full text Add to dashboard Cite

ObjectivesTo determine the possible interactions between levodopa therapy and plasma levels of B vitamins in patients with advanced idiopathic Parkinson's disease (IPD) in the context of either oral levodopa therapy or levodopa/carbidopa intestinal gel (LCIG). Secondly, to determine the prevalence of neuropathy and its relation to plasma levels of B vitamins and homocysteine.MethodsMedication doses, neurographies, and serum levels of pyridoxine, cobalamin, folate, and homocysteine of eight LCIG and 13 orally treated advanced IPD patients matched for age, Hoehn & Yahr stage, and UPRDS III were collected. This data was analyzed for correlation with daily levodopa dose (LDD).Results LICG patients had a longer disease duration and higher LDD. All LCIG patients and most orally treated patients had sensorimotor axonal polyneuropathy. Of all plasma vitamin levels, pyridoxine was decreased most and significantly lower in the LCIG group. Cobalamin and folate, however, were within the lower reference range, and homocysteine highly elevated, all without any significant difference between both groups. LDD correlated significantly with pyridoxine deficiency (p = .02) irrespective of the route of application and with hyperhomocysteinemia in the LCIG group (p = .03). At LDDs above 2,000 mg, pyridoxine deficiency was almost always detectable.ConclusionsPyridoxine deficiency and hyperhomocysteinemia are dependent on the daily levodopa/carbidopa dose, while levels of cobalamin and folate are not. The mode of application of levodopa/carbidopa has no impact on B‐vitamin levels. Neuropathy is very frequent in advanced IPD; however, it remains to be investigated further whether neuropathy is more frequent in LCIG than in orally levodopa/carbidopa‐treated advanced IPD patients.

show abstract

Section: Introductionmentioning

confidence: 99%

Effects of levodopa/carbidopa intestinal gel versus oral levodopa/carbidopa on B vitamin levels and neuropathy

et al. 2017

View full text Add to dashboard Cite

show abstract

“…One patient improved with vitamin B12/B6 supplementation. As previously mentioned, in a smaller earlier trial, one of the nine patients developed neuropathy after starting the infusion [65].…”

Section: Continuous Duodenal Levodopa Infusionmentioning

confidence: 51%

“…This also may occur if the distal end of the tube is displaced to the stomach, or there may be re-emergence of motor complications with variability in gastric emptying. In another open-label prospective trial, nine advanced PD patients receiving intraduodenal infusion were followed for 12 months [65]. Two of the nine patients withdrew from therapy.…”

Section: Continuous Duodenal Levodopa Infusionmentioning

confidence: 99%

Continuous dopaminergic delivery to minimize motor complications in Parkinson’s disease

Wright

Waters²

2013

Expert Review of Neurotherapeutics

View full text Add to dashboard Cite

“…12,13,[35][36][37][38][39][40][41][42][43][44][45][46] Most studies so far have focused on motor symptoms. The general finding is that LCIG provides more time in motor states near normal performance and less time in 'off' and dyskinetic states as compared to conventional optimised therapy.…”

Section: Long-term Efficacy With Levodopa/carbidopa Intestinal Gel Inmentioning

confidence: 99%

Long-term Efficacy and Safety with Continuous Dopaminergic Stimulation Pump Treatments in Parkinson’s Disease

Busk¹,

Johansson²,

Nyholm³

2011

European Neurological Review

View full text Add to dashboard Cite

Continuous dopaminergic stimulation (CDS) is important for symptom control in advanced stages of Parkinson's disease (PD). The most efficacious approaches are pump treatments with dopaminergic drugs: subcutaneous infusion of the dopamine receptor agonist apomorphine and intestinal infusion of levodopa/carbidopa gel. Both methods decrease motor fluctuations in long-term follow-ups, including parkinsonian and dyskinetic states, when compared to conventional optimised oral therapy. Also non-motor symptoms may be improved. Adverse drug reactions are usually less pronounced although high levodopa doses, which are common with levodopa/carbidopa infusion, may cause hyperhomocysteinaemia and cobalamin deficiency. Technical complications are specific for each infusion strategy. Formation of subcutaneous nodules is the most common problem with apomorphine infusion. Dislocation of the intestinal tube is the most common problem with levodopa/carbidopa infusion. Both pump treatments may be used for 24-hour infusion in selected patients. The long-term experience is reviewed. To conclude, CDS pump treatments may be successfully used for several years in advanced PD. KeywordsApomorphine, continuous dopaminergic stimulation, infusion, levodopa/carbidopa, Parkinson's disease, pump The background is a combination of a number of findings, mainly that:• striatal dopaminergic stimulation is fairly constant in a healthy brain;• striatal dopaminergic stimulation in PD is pulsatile when oral levodopa is used; • pulsatile dopaminergic stimulation causes motor fluctuations and dyskinesias; and • continuous administration of dopaminergic agents may decrease motor fluctuations and reverse dyskinesias.PD is associated with a more widespread pathology than nigro-striatal degeneration and CDS is not the remedy for all problems. But there is firm evidence that continuous dopaminergic drug delivery, probably providing CDS, produces a significant benefit compared to conventional therapy in patients with advanced PD. The evidence mainly stems from studies of levodopa and apomorphine infusions.

show abstract

Duodenal levodopa infusion for advanced Parkinson's disease: 12‐month treatment outcome

Cited by 213 publications

References 17 publications

Effects of levodopa/carbidopa intestinal gel versus oral levodopa/carbidopa on B vitamin levels and neuropathy

Effects of levodopa/carbidopa intestinal gel versus oral levodopa/carbidopa on B vitamin levels and neuropathy

Continuous dopaminergic delivery to minimize motor complications in Parkinson’s disease

Long-term Efficacy and Safety with Continuous Dopaminergic Stimulation Pump Treatments in Parkinson’s Disease

Contact Info

Product

Resources

About