Journal of Neurology

, Volume 259, Issue 8, pp 1668–1672

Polyneuropathy while on duodenal levodopa infusion in Parkinson’s disease patients: we must be alert

  • Diego Santos-García
  • Raúl de la Fuente-Fernández
  • Francesc Valldeoriola
  • Antonio Palasí
  • Fátima Carrillo
  • Mónica Grande
  • Pablo Mir
  • Oriol De Fabregues
  • Jordi Casanova
Original Communication

DOI: 10.1007/s00415-011-6396-z

Cite this article as:
Santos-García, D., de la Fuente-Fernández, R., Valldeoriola, F. et al. J Neurol (2012) 259: 1668. doi:10.1007/s00415-011-6396-z

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.

Keywords

CobalaminDuodenal levodopa infusionGuillain-Barré syndromeHomocysteinePolyneuropathy

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

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • Diego Santos-García
    • 1
  • Raúl de la Fuente-Fernández
    • 1
  • Francesc Valldeoriola
    • 2
  • Antonio Palasí
    • 3
  • Fátima Carrillo
    • 4
  • Mónica Grande
    • 5
  • Pablo Mir
    • 4
    • 6
  • Oriol De Fabregues
    • 3
  • Jordi Casanova
    • 7
  1. 1.Section of NeurologyHospital A. MarcideFerrolSpain
  2. 2.Movement Disorders Unit, Department of Neurology, Institut Clínic de Malalties del Sistema NerviosHospital Clinic, University of BarcelonaBarcelonaSpain
  3. 3.Movement Disorders Unit, Department of Neurology, Institut de Recerca Vall d′HebrónHospital Universitari Vall d′Hebrón, University of BarcelonaBarcelonaSpain
  4. 4.Movement Disorders Unit, Deparment of Neurology and Neurophysiology, Instituto de Biomedicina de Sevilla (IBiS)Hospital Universitario Virgen del Rocío/CSIC/Universidad de SevillaSevilleSpain
  5. 5.Department of NeurophysiologyHospital A. MarcideFerrolSpain
  6. 6.Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED)MadridSpain
  7. 7.Depatment of NeurophysiologyHospital Clinic, University of BarcelonaBarcelonaSpain