Long-term levodopa/carbidopa intestinal gel in advanced Parkinson’s disease

Abstract

The short-term benefits of levodopa/carbidopa intestinal gel (LCIG) in patients with advanced Parkinson's disease (PD) are well documented, but the long-term benefits are still uncertain. The aim of this study was to investigate the motor and cognitive outcome of LCIG treatment in advanced PD after a follow-up period of at least 24 months. We assessed 29 patients with advanced PD who started LCIG infusion at our centre between 2007 and 2013. Motor fluctuations, parkinsonian symptoms, activities of daily living and impact on quality of life were evaluated. We also investigated the cognitive outcome using a battery of neuropsychological tests. All adverse events were recorded. Of the 29 PD patients who initiated LCIG, 16 patients reached the follow-up evaluation (24 months), after a mean time period of 32.2 ± 12.4 months. Six patients did not fulfil the 24-month follow-up visit and were evaluated after a mean time period of 8.6 ± 5.4 months. Seven patients discontinued the treatment before the scheduled visit. "Off" time and "On" dyskinesia duration were significantly reduced. LCIG improved quality of life and non motor symptoms, despite overall unchanged total levodopa doses prior to LCIG beginning. Motor and cognitive decline were detected. A relatively high number of adverse events occurred during the follow-up, above all, technical problems with the infusion device and mild problems related with gastrostomy. There were four cases of peripheral neuropathy (PN), 2 of which were considered serious. Our data confirm that LCIG is beneficial in the long-term treatment of advanced PD patients despite a decline in cognitive functions in a subgroup of patients, probably due to disease progression. PN in patients with LCIG may be more frequent than the published date suggest.

Improvement of dyskinesias withl-dopa infusion in advanced Parkinson's disease

“…The results confirm and strengthen the findings from earlier studies indicating an antidyskinetic effect of this treatment (12,15,(32)(33)(34)(35)(36). Our results are also in accord with previous studies concerning the effects on off-time and HRQoL in patients with PD.…”

Polyneuropathy associated with duodenal infusion of levodopa in Parkinson's disease: features, pathogenesis and management

“…In five acute and four subacute patients, antibodies to gangliosides were absent (current case) 15 17. In two subacute patients, antibodies to gangliosides were reported to be present although the specific antibodies, the Ig isotype and the titre were not indicated 11.…”

“…In acute patients, vitamin B 12 level was decreased in 2/7 and folate in 5/6 patients; Hcy was increased in 6/9 and MMA in 2/2 patients (current case) 9 15 20…”

“…The patient we report had gastroenteritis 2 weeks before onset of PNP. Weight loss preceding or concomitant to the onset of PNP was reported in 1 acute and 3 subacute patients with PNP 15 17 19. One patient, 2 weeks after the onset of distal paresthaesias and numbness, fell and underwent surgery under general anaesthesia with nitrous oxide inhalation 9.…”

Levodopa-carbidopa enteral suspension in advanced Parkinson’s disease: clinical evidence and experience

“…Significant improvements it QoL measures were observed at follow ups of 2 years and 25.8 ± 19.5 months in studies in Spain and Italy [Antonini et al 2008;Cáceres-Redondo et al 2014;Zibetti et al 2014].…”