Abstract
Some reports have emerged describing the occurrence of Guillain-Barré syndrome and polyneuropathy related to vitamin B12 deficiency in some patients with Parkinson’s disease (PD) treated with continuous duodenal levodopa infusion. We describe five PD patients who developed axonal polyneuropathy and vitamin B12 deficiency while on treatment with duodenal levodopa infusion, review other cases reported in the literature, discuss potential etiologic factors, and suggest a possible algorithm for the management and prevention of this complication. One case of Guillain-Barré syndrome and at least 12 cases of polyneuropathy related to vitamin B12 deficiency have been reported in PD patients treated with duodenal levodopa infusion. Levodopa gel infusion may induce a decrease in vitamin B12 levels, leading to peripheral neuropathy. Additional pathogenetic mechanisms include alterations related to the metabolism of l-dopa, abnormal l-dopa absorption, and direct neurotoxicity of l-dopa at high doses. Vitamin B12 supplementation may need to be considered in PD patients on duodenal levodopa infusion therapy. Vitamin B12 deficiency in patients on duodenal levodopa infusion therapy may be more frequent than the published data suggest. We must be alert.
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Abbreviations
- CMV:
-
Cytomegalovirus
- COMT:
-
Catechol O-methyltransferase
- CSF:
-
Cerebrospinal fluid
- DLI:
-
Duodenal levodopa infusion
- EBV:
-
Ebstein-Barr virus
- GBS:
-
Guillain-Barré syndrome
- Hcy:
-
Homocysteine
- HSV:
-
Herpes simplex virus
- MAO:
-
Monoamine oxidase
- MMA:
-
Methylmalonic acid
- OMD:
-
O-Methyldopa
- PD:
-
Parkinson’s disease
- SAH:
-
S-adenosylhomocysteine
- SAM:
-
S-adenosylmethionine
- VB12:
-
Vitamin B12
- VB12-PNP:
-
Vitamin B12 deficiency polyneuropathy
- VZV:
-
Varicella zoster virus
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Acknowledgments
F. Carrillo and P. Mir were supported by grants from the Ministerio de Ciencia e Innovación de España (SAF2007-60700); the Instituto de Salud Carlos III (PI10/01674); the Consejería de Innovación, Ciencia y Empresa de la Junta de Andalucía (CVI-02526); the Consejería de Salud de la Junta de Andalucía (PI-0377/2007, PI-0741/2010), the Sociedad Andaluza de Neurología and the Jaques and Gloria Gossweiler Foundation. The remaining authors received no relevant financial support and funding for the preceding 12 months.
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The authors report no conflicts of interest. The authors have not received any honorarium related to this work.
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Santos-García, D., de la Fuente-Fernández, R., Valldeoriola, F. et al. Polyneuropathy while on duodenal levodopa infusion in Parkinson’s disease patients: we must be alert. J Neurol 259, 1668–1672 (2012). https://doi.org/10.1007/s00415-011-6396-z
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DOI: https://doi.org/10.1007/s00415-011-6396-z