Long-term duodenal levodopa infusion in Parkinson’s disease: a 3-year motor and cognitive follow-up study
- 1.1k Downloads
Duodenal infusion of levodopa/carbidopa gel (Duodopa) is an effective treatment option for advanced Parkinson’s disease (PD). Long-term clinical experience up to 16 years suggests that the safety of this procedure is acceptable, while several observational studies showed that Duodopa reduces motor fluctuations and dyskinesias improving patients’ quality of life (QoL). The aim of this study is to investigate the long-term motor and cognitive outcome of Duodopa treatment in advanced PD patients and its’ impact on the QoL. Twenty-five consecutive PD patients were assessed using the Unified PD rating scale (UPDRS), a battery of neuropsychological tests, and the PD questionnaire (PDQ-39) at baseline and after a mean period of three years of Duodopa treatment. Seventeen out of 25 patients reached the follow-up evaluation; five patients discontinued Duodopa and three patients died of causes unrelated to drug infusion. Duodopa improved motor complications (UPDRS-IV) and quality of life (PDQ-39). A sub-group of subjects (41 %) developed a significant deterioration of cognitive functions over time. The most common adverse events were dislocation and the kinking of the intestinal tube. In conclusion, Duodopa therapy is effective in the long-term treatment of advanced PD patients. Continuous enteral levodopa infusion achieves a reduction of motor fluctuations and dyskinesias improving patients’ QoL, despite the progression of PD motor symptoms and a significant decline in cognitive functions in a sub-group of patients.
KeywordsParkinson’s disease Levodopa/carbidopa duodenal infusion Motor fluctuations Dyskinesias
Conflicts of interest
The authors declare that they have no conflict of interest.
The study has been approved by the San Giovanni Battista Molinette Hospital ethics committee and has therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki.
- 10.Santos-García D, Sanjurjo LF, Macías M, Llaneza M, Carpintero P, de la Fuente-Fernández R (2012) Long-term exposure to duodenal levodopa/carbidopa infusion therapy improves quality of life in relation especially to mobility, activities of daily living, and emotional well-being. Acta Neurol Scand 125:187–191PubMedCrossRefGoogle Scholar
- 12.Honig H, Antonini A, Martinez-Martin P, Forgacs I, Faye GC, Fox T, Fox K, Mancini F, Canesi M, Odin P, Chaudhuri KR (2009) Intrajejunal levodopa infusion in Parkinson’s disease: a pilot multicenter study of effects on nonmotor symptoms and quality of life. Mov Disord 24:1468–1474PubMedCrossRefGoogle Scholar
- 21.Raven JC (ed) (1962) Coloured progressive matrices. Lewin, LondonGoogle Scholar
- 22.Spinnler H, Tognoni G (1987) Standardizzazione e Taratura italiana di Test Neuropsicologici. Italian J Neurol Sci 6:23–24Google Scholar
- 26.Freedman M, Leach L, Kaplan E, Winocur G, Shulman KJ, Delis DC (1994) Clock drawing. A neuropsichological analysis. Oxford University Press, New YorkGoogle Scholar