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Improvement of impulse control disorders associated with levodopa–carbidopa intestinal gel treatment in advanced Parkinson’s disease

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Impulse control behaviors are a frequent comorbidity for patients with Parkinson’s disease (PD). The objective of the present study was to evaluate the effectiveness levodopa–carbidopa intestinal gel (LCIG) therapy on impulse control disorders (ICDs) in patients with advanced PD. We conducted a multicenter, observational, and prospective (6 months follow-up) study that included consecutive PD patients assigned to LCIG through routine medical practice. Patients completed visits at baseline, 1, 3, and 6 months after percutaneous endoscopic gastrostomy procedure. The following outcomes were evaluated: presence and severity of ICDs and other neuropsychiatric disorders, sleep disturbances, patients’ quality of life, and caregivers’ burden. Sixty-two patients were included at baseline: mean age 72.2 years (SD ± 7.0), 42% women. Median duration of PD symptoms was 13.5 years (IQR 5.5–21.5) and median time with motor fluctuations was 5.0 years (IQR 1.0–9.0). Treatment with LCIG infusion was associated with progressive and significant improvements in ICDs symptoms over the study period (64.4% reduction in the Questionnaire for Impulsive–Compulsive Disorders in Parkinson’s disease—Rating Scale score). Psychotic and other neuropsychiatric symptoms were also significantly reduced, and patients’ sleep quality and psychosocial function improved. Caregivers’ burden remained unchanged. There was a significant improvement in the daily “Off” time [7.4 h (SD ± 4.0) vs 1.5 h (SD ± 1.8); p < 0.0001] at the end of follow-up, whereas duration of dyskinesias was not affected. ICDs significantly improved after 6-month LCIG treatment in a group of PD patients with mild-to-moderate neuropsychiatric disturbances.

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This work was supported by Abbvie and the Foundation Neurociencias y Envejecimiento. Abbvie provided financial support for study implementation, data collection, and data analysis, but was not involved in the conduct or management of the study, or analysis or interpretation of data, or preparation of the paper.

The authors acknowledge all the patients and caregivers participating in this study. Thanks go to the team of nurses from all centers for their helpful collaboration, especially to Natividad Mariscal, Maravillas Bernal, Beatriz Gonzalez-Garcia, and Laura Vargas-Gonzalez. The authors also thank Karma Research S. L. for study monitoring, Análisis Estadísticos PeRTICA, S. L. for statistical analysis contribution, and Anabel Herrero for writing assistance (these services were funded by Abbvie).

Co-investigators (EDIS Study Group): Alejandro Barroso-Merinero (Hospital Universitario La Princesa, Madrid), Juan P Cabello de la Rosa (Hospital General Universitario de Ciudad Real), M Teresa Cáceres-Redondo (Hospital Universitario Virgen del Rocío, Sevilla), Fatima Carrillo (Hospital Universitario Virgen del Rocío, Sevilla), Elvira García-Cobos (Hospital Puerta de Hierro, Madrid), Itciar Gaston-Zubimendi (Complejo Hospitalario de Navarra, Pamplona, Navarra), María J Gómez-Heredia (Hospital Universitario Virgen de la Victoria, Málaga), Jaime Herreros-Rodríguez (Hospital Universitario 12 de Octubre, Madrid), Silvia Jesús (Hospital Universitario Virgen del Rocío, Sevilla), Lidia López (Hospital Universitario La Princesa, Madrid), Nuria Lopez-Ariztegui (Hospital Virgen de la Salud, Toledo), Juan J López-Lozano (Hospital Puerta de Hierro, Madrid), Rocío Malo de Molina (Hospital Insular de Las Palmas, Gran Canaria), Javier Marco-Llorente (Hospital Clínico Universitario de Valladolid), Idaira Martin-Santana (Hospital Insular de Las Palmas, Gran Canaria), Marina Mata (Hospital Puerta de Hierro, Madrid), Paloma Montero (Hospital Clínico San Carlos, Madrid), Francisco Perez-Errasquin (Hospital Universitario Virgen de la Victoria, Málaga), Ana Rojo (Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid), Julia Vaamonde (Hospital General Universitario de Ciudad Real).

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Authors and Affiliations




MJC designed the study, interpreted data, and drafted, edited, and submitted the final article. AMA, PM, EC, and JMA contributed to recruitment of patients and the overall implementation of the study, revised the manuscript, and approved the final version to be published. PMM contributed to the design of the study and statistical analyses, revised the manuscript, and approved the final version to be published.

Corresponding author

Correspondence to Maria Jose Catalan.

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Ethical standards

The study complies with the Declaration of Helsinki. Local ethics committees approved the EDIS study.

Conflicts of interest

Maria Jose Catalan has received honoraria for consulting, advisory services, speaking services and research from AbbVie Laboratories and Merz. Antonio Molina-Arjona declares he has no conflict of interest. Pablo Mir has received honoraria for lecturing or advisory boards from AbbVie, UCB, Allergan, and Merz, and research grants from the Ministerio de Economía y Competitividad de España [SAF2007-60700], Instituto de Salud Carlos III [PI10/01674, CP08/00174, PI13/01461], Consejería de Economía, Innovación, Ciencia y Empleo de la Junta de Andalucía [CVI-02526, CTS-7685], Consejería de Salud y Bienestar Social de la Junta de Andalucía [PI-0377/2007, PI-0741/2010, PI-0437-2012], Sociedad Andaluza de Neurología, the Jacques and Gloria Gossweiler Foundation, and the Fundación Alicia Koplowitz. Esther Cubo has received travel grant to meetings from Abbvie and Allergan; speaker honorarium from Abbvie and UCB. Jose Matias Arbelo has received honoraria for educational presentations or clinical studies participation by Abbvie, UCB Pharma and Italfarmaco. Pablo Martinez-Martin has received honorarium from Editorial Viguera and Movement Disorder Society for lecturing in courses; from AbbVie for speaking in experts’ meetings and for participating in the Advisory Board of an epidemiological study. Grant: from the International Parkinson and Movement Disorder Society for the Pilot Study of the MDS-Non-Motor Symptoms Scale.

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All patients and caregivers provided written informed consent.

Additional information

Members of the EDIS Study Group are listed in acknowledgements section.

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Catalan, M.J., Molina-Arjona, J.A., Mir, P. et al. Improvement of impulse control disorders associated with levodopa–carbidopa intestinal gel treatment in advanced Parkinson’s disease. J Neurol 265, 1279–1287 (2018).

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