Subacute axonal neuropathy in Parkinson's disease with cobalamin and vitamin B6 deficiency under duodopa therapy

Abstract

We describe two patients who developed subacute axonal peripheral neuropathy under duodopa treatment. Comprehensive diagnostic workup including muscle and sural nerve biopsy revealed that the most probable cause of subacute axonal peripheral neuropathy was cobalamin and vitamin B6 deficiency in both the patients.

Neuropathy and levodopa in Parkinson's disease: Evidence from a multicenter study

“…The positive association of neuropathy with both vitamin B12 deficiency and increased Hcy levels observed in our study replicates on a larger scale the data previously published . In particular, our findings are confirmatory of the data originally described by Rajabally and Martey, who reported for the first time a positive relationship between neuropathy and low vitamin B12 levels, as well as recent data regarding a strong association between neuropathy and increased Hcy levels …”

“…The positive association of neuropathy with both vitamin B12 deficiency and increased Hcy levels observed in our study replicates on a larger scale the data previously published. [1][2][3]9,10 In particular, our findings are confirmatory of the data originally described by Rajabally and Martey, who reported for the first time a positive relationship between neuropathy and low vitamin B12 levels, 3 as well as recent data regarding a strong association between neuropathy and increased Hcy levels. 1,2 The increase in Hcy during oral L-dopa as well as duodopa intestinal infusion [11][12][13][14] are related to the consumption of methyl groups by COMT; vitamin B12, vitamin B6, and folate are needed cofactors for Hcy metabolism.…”

Neuropathy and levodopa in Parkinson's disease: Evidence from a multicenter study

“…The positive association of neuropathy with both vitamin B12 deficiency and increased Hcy levels observed in our study replicates on a larger scale the data previously published . In particular, our findings are confirmatory of the data originally described by Rajabally and Martey, who reported for the first time a positive relationship between neuropathy and low vitamin B12 levels, as well as recent data regarding a strong association between neuropathy and increased Hcy levels …”

“…The positive association of neuropathy with both vitamin B12 deficiency and increased Hcy levels observed in our study replicates on a larger scale the data previously published. [1][2][3]9,10 In particular, our findings are confirmatory of the data originally described by Rajabally and Martey, who reported for the first time a positive relationship between neuropathy and low vitamin B12 levels, 3 as well as recent data regarding a strong association between neuropathy and increased Hcy levels. 1,2 The increase in Hcy during oral L-dopa as well as duodopa intestinal infusion [11][12][13][14] are related to the consumption of methyl groups by COMT; vitamin B12, vitamin B6, and folate are needed cofactors for Hcy metabolism.…”

Prospective assessment of peripheral neuropathy in Duodopa-treated parkinsonian patients

“…Nevertheless, similarly to other cases reported in literature , also in our cohort, one patient developed a subacute PN; at baseline, this subject did not show any clinical, electrophysiological or biochemical alteration that may had been correlated with the following clinical evolution.…”

“…On the other side, one patient developed a subacute severe sensory‐motor multineuropathy, with prolonged distal motor latencies, motor nerve conduction blocks and reduced nerve conduction velocities. It could be hypothesized that immune‐mediated responses or, alternatively, an acute vitamin adsorption deficiency might have played a role in the pathogenesis of this case, which resembles other PN reported in patients treated with Duodopa .…”

Levodopa/carbidopa intestinal gel infusion in advanced Parkinson's disease: a 7‐year experience

“…Finally, in relation to LCIG infusion, several cases of weight loss requiring dietary integration and nutri-tional status monitoring were observed. In keeping with recent reports [23][24][25], four cases of polyneuropathy were also observed: one patient developed a severe subacute sensory-motor multineuropathy after 4 months of LCIG treatment and a decision was made to stop LCIG infusion, whereas three subjects with pre-existing mild polyneuropathy showed a worsening of electrophysiological and clinical features. LCIG treatment was not interrupted in these subjects, but vitamin B12 supplementation and strict clinical and electrophysiological monitoring was carried out.…”

Neuropathy and levodopa in Parkinson's disease: Evidence from a multicenter study

“…The positive association of neuropathy with both vitamin B12 deficiency and increased Hcy levels observed in our study replicates on a larger scale the data previously published . In particular, our findings are confirmatory of the data originally described by Rajabally and Martey, who reported for the first time a positive relationship between neuropathy and low vitamin B12 levels, as well as recent data regarding a strong association between neuropathy and increased Hcy levels …”

“…The positive association of neuropathy with both vitamin B12 deficiency and increased Hcy levels observed in our study replicates on a larger scale the data previously published. [1][2][3]9,10 In particular, our findings are confirmatory of the data originally described by Rajabally and Martey, who reported for the first time a positive relationship between neuropathy and low vitamin B12 levels, 3 as well as recent data regarding a strong association between neuropathy and increased Hcy levels. 1,2 The increase in Hcy during oral L-dopa as well as duodopa intestinal infusion [11][12][13][14] are related to the consumption of methyl groups by COMT; vitamin B12, vitamin B6, and folate are needed cofactors for Hcy metabolism.…”

Prospective assessment of peripheral neuropathy in Duodopa-treated parkinsonian patients

“…Nevertheless, similarly to other cases reported in literature , also in our cohort, one patient developed a subacute PN; at baseline, this subject did not show any clinical, electrophysiological or biochemical alteration that may had been correlated with the following clinical evolution.…”

“…On the other side, one patient developed a subacute severe sensory‐motor multineuropathy, with prolonged distal motor latencies, motor nerve conduction blocks and reduced nerve conduction velocities. It could be hypothesized that immune‐mediated responses or, alternatively, an acute vitamin adsorption deficiency might have played a role in the pathogenesis of this case, which resembles other PN reported in patients treated with Duodopa .…”

Levodopa/carbidopa intestinal gel infusion in advanced Parkinson's disease: a 7‐year experience

“…Finally, in relation to LCIG infusion, several cases of weight loss requiring dietary integration and nutri-tional status monitoring were observed. In keeping with recent reports [23][24][25], four cases of polyneuropathy were also observed: one patient developed a severe subacute sensory-motor multineuropathy after 4 months of LCIG treatment and a decision was made to stop LCIG infusion, whereas three subjects with pre-existing mild polyneuropathy showed a worsening of electrophysiological and clinical features. LCIG treatment was not interrupted in these subjects, but vitamin B12 supplementation and strict clinical and electrophysiological monitoring was carried out.…”

Neuropathy and levodopa in Parkinson's disease: Evidence from a multicenter study

“…The positive association of neuropathy with both vitamin B12 deficiency and increased Hcy levels observed in our study replicates on a larger scale the data previously published . In particular, our findings are confirmatory of the data originally described by Rajabally and Martey, who reported for the first time a positive relationship between neuropathy and low vitamin B12 levels, as well as recent data regarding a strong association between neuropathy and increased Hcy levels …”

“…The positive association of neuropathy with both vitamin B12 deficiency and increased Hcy levels observed in our study replicates on a larger scale the data previously published. [1][2][3]9,10 In particular, our findings are confirmatory of the data originally described by Rajabally and Martey, who reported for the first time a positive relationship between neuropathy and low vitamin B12 levels, 3 as well as recent data regarding a strong association between neuropathy and increased Hcy levels. 1,2 The increase in Hcy during oral L-dopa as well as duodopa intestinal infusion [11][12][13][14] are related to the consumption of methyl groups by COMT; vitamin B12, vitamin B6, and folate are needed cofactors for Hcy metabolism.…”

Prospective assessment of peripheral neuropathy in Duodopa-treated parkinsonian patients

“…Nevertheless, similarly to other cases reported in literature , also in our cohort, one patient developed a subacute PN; at baseline, this subject did not show any clinical, electrophysiological or biochemical alteration that may had been correlated with the following clinical evolution.…”

“…On the other side, one patient developed a subacute severe sensory‐motor multineuropathy, with prolonged distal motor latencies, motor nerve conduction blocks and reduced nerve conduction velocities. It could be hypothesized that immune‐mediated responses or, alternatively, an acute vitamin adsorption deficiency might have played a role in the pathogenesis of this case, which resembles other PN reported in patients treated with Duodopa .…”

Levodopa/carbidopa intestinal gel infusion in advanced Parkinson's disease: a 7‐year experience

“…Finally, in relation to LCIG infusion, several cases of weight loss requiring dietary integration and nutri-tional status monitoring were observed. In keeping with recent reports [23][24][25], four cases of polyneuropathy were also observed: one patient developed a severe subacute sensory-motor multineuropathy after 4 months of LCIG treatment and a decision was made to stop LCIG infusion, whereas three subjects with pre-existing mild polyneuropathy showed a worsening of electrophysiological and clinical features. LCIG treatment was not interrupted in these subjects, but vitamin B12 supplementation and strict clinical and electrophysiological monitoring was carried out.…”