Duodenal levodopa infusion for advanced Parkinson's disease: 12-month treatment outcome.
We assessed prospectively clinical and quality of life changes in 9 patients with Parkinson's disease (PD; H&Y > or = 3) with severe motor fluctuations and dyskinesia who started continuous daily levodopa duodenal infusion through percutaneous endoscopic gastrostomy. Seven patients completed the follow-up period. Duration of "off" periods and time with disabling dyskinesia shortened significantly in all patients (P < 0.01). Total daily dose of levodopa infused did not differ from baseline equivalents. There were significant improvements in UPDRS-II (activities of daily living) and -IV (motor complications) in the "on" condition (P < 0.02), and in four PDQ-39 domains (mobility, activities of daily living, stigma, bodily discomfort; P < 0.05). Two patients withdrew for adverse events. Our results demonstrate that a satisfactory therapeutic window can be achieved and maintained for several months in advanced PD patients.
Parkinson Institute, Istituti Clinici di Perfezionamento, Milan, Italy. angelo3000@yahoo.com
Angelo
A
Antonini
Ioannis U
IU
Isaias
Margherita
M
Canesi
Maurizio
M
Zibetti
Francesca
F
Mancini
Luigi
L
Manfredi
Marco
M
Dal Fante
Leonardo
L
Lopiano
Gianni
G
Pezzoli
D000368:Aged; D000369:Aged, 80 and over; D000978:Antiparkinson Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D002230:Carbidopa / Q000627:therapeutic use; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D004386:Duodenum; D020820:Dyskinesias / Q000175:diagnosis / Q000503:physiopathology; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D007980:Levodopa / Q000008:administration & dosage / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000188:drug therapy*; D011446:Prospective Studies; D011788:Quality of Life / Q000523:psychology; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome
D000978:Antiparkinson Agents; D007980:Levodopa; D002230:Carbidopa