Using tube feeding and levodopa-carbidopa intestinal gel application in advanced Parkinson's disease

Abstract

The inability to achieve adequate nutrition and weight loss are serious problems for patients with advanced Parkinson's disease (PD). To ensure the optimal intake of nutrition and fluids and to administer levodopa-carbidopa intestinal gel (LCIG) (which patients need to increase or maintain their mobility as long as possible), different artificial feeding tubes can be used. Although percutaneous endoscopic gastrostomy (PEG) tubes are frequently used in medical practice, there is little research that addresses key questions, including if and when to administer artificial fluids, nutrition and/or LCIG via tubes. Weight gain through tube feeding is only possible for some patients; nurses should keep in mind that tube insertion and feeding may lead to frequent adverse events. Administering LCIG via tubes is usually advisable as it seems to enhance patients' mobility and therefore has positive outcomes in terms of the quality of life of patients and their families ( Lim et al, 2015 ). The authors aimed to examine the use and consequences of providing nutrition and LCIG via gastrostomy tubes in PD patients with advanced disease.

Consensus-Based Recommendations for Advance Directives of People with Parkinson’s Disease in Regard to Typical Complications by German Movement Disorder Specialists

“…In case of non-oral advanced therapies, the patient should be informed in advance of the additive palliative care value of an intervention. This information may help the patient to early visualize later secondary advances which is also in line with the patients' wishes for more information on palliative care [3,24]. In addition to oral administration, the medication can also be administered non-orally via patch, injection or pump.…”

“…In addition to oral administration, the medication can also be administered non-orally via patch, injection or pump. In the case of levodopa carbidopa intestinal gel it can also be used for artificial nutrition [24]. By applying these recommendations, patients can decide in advance whether a drug pump should be part of the therapy if severe swallowing disorders occur.…”

The Prephase Nursing in Levodopa Carbidopa Intestinal Gel Therapy

“…8 In more complicated clinical conditions, severe malnutrition could cause patients' physical deterioration. 6 A multidisciplinary team approach is always recommended in guidelines for the treatment of PD, but there is no standard of care for such an approach, and the guidelines do not provide clarification on how it should be implemented. The selection and identification phase of the LCIG candidate is not structured according to identified procedures.…”

Advance Directives of German People with Parkinson’s Disease Are Unspecific in regard to Typical Complications

“…A specific feature of LCIG therapy is the possibility of additional nutrition of the patient via the gastric line. The patient under LCIG therapy could state if he wants to receive nutrition or water supplementation, or rather refuse this therapy in an end-of-life setting [26].…”