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Duodenal Levodopa Infusion Improves Quality of Life in Advanced Parkinson’s Disease

2008; Karger Publishers; Volume: 5; Issue: 3-4 Linguagem: Inglês

10.1159/000113714

1660-2862

Angelo Antonini, Francesca Mancini, Margherita Canesi, Roberta Zangaglia, Ioannis U. Isaias, L Manfredi, Claudio Pacchetti, Maurizio Zibetti, F. Natuzzi, Leonardo Lopiano, Giuseppe Nappi, Gianni Pezzoli,

Neurological and metabolic disorders

<i>Background:</i> A significant percentage of patients with Parkinson’s disease (PD) continue to experience motor fluctuations and dyskinesias despite the association of dopamine agonists and levodopa with COMT or MAO-B inhibitors. The use of apomorphine infusion is limited by compliance while deep brain stimulation is feasible only for a small number of patients mostly because of age constraints. <i>Objective:</i> To assess prospectively the effectiveness of duodenal levodopa infusion on quality of life as well as motor features in patients with advanced PD. In all but 1 case levodopa infusion was stopped at nighttime. <i>Methods: </i>We report the outcome of 22 PD patients, followed for up to 2 years, who were on continuous duodenal levodopa/carbidopa infusion through percutaneous endoscopic gastrostomy. <i>Results:</i> We found a significant reduction in ‘off’ period duration as well as dyskinesia severity (Unified Parkinson’s Disease Rating Scale part IV, items 33 and 39). There was significant improvement in the 39-item Parkinson’s Disease Quality of Life Questionnaire as well as in the Unified Parkinson’s Disease Rating Scale part II up to the 2-year follow-up. Five patients withdrew: 2 for poor compliance and 3 for adverse events (1 was related to percutaneous endoscopic gastrostomy). <i>Conclusions:</i> These results demonstrate significant clinical improvements in quality of life and activities of daily living consistent with the occurrence of a satisfactory therapeutic response and a reduction in dyskinesia severity.