Continuous jejunal levodopa infusion in patients with advanced parkinson disease: practical aspects and outcome of motor and non-motor complications.
OBJECTIVE
We report here on the experience with continuous jejunal levodopa infusion in 13 German parkinsonian patients who have motor and nonmotor complications despite individually optimized oral treatment. The tolerability, efficacy, and the need for dose adjustment of levodopa infusion were followed-up prospectively. Thereby, we describe clinically relevant details for how to successfully initiate and handle this new treatment strategy.


METHODS
Thirteen patients with advanced Parkinson disease (PD) who have motor fluctuations and dyskinesia were switched off their conventional PD medication to continuous levodopa infusion and followed-up within a maximum period of 12 months.


RESULTS
Time in "off" represented a mean of 50% (+/-14; n = 13) of awake time before levodopa infusion and was reduced to a mean of 11% (+/-9; n = 11) of awake time after 6 months. Time in "on with disabling dyskinesias" represented a mean of 17% (+/-15; n = 13) of awake time before levodopa infusion and was reduced to a mean of 3% (+/-6; n= 11) of awake time after 6 months, thereby increasing the time in good "on" state. A positive effect on nonmotor symptoms (anxiety, sleep disturbances) was also observed. In most cases, dose adjustment was required within the first 6 months (predominantly after months 1-3). The therapy was safe and effective. However, problems with the technical device were common.


CONCLUSIONS
Continuous jejunal levodopa infusion is an effective and feasible alternative treatment option for patients with advanced PD who can cope with and tolerate the device.
Department of Neurology, Philipps-University of Marburg, Marburg, Germany. eggert@med.uni-marburg.de
Karla
K
Eggert
Christoph
C
Schrader
Michaela
M
Hahn
Maria
M
Stamelou
Anne
A
Rüssmann
Reinhard
R
Dengler
Wolfgang
W
Oertel
Per
P
Odin
D000328:Adult; D000978:Antiparkinson Agents / Q000008:administration & dosage*; D002404:Catheterization; D020820:Dyskinesias / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D006801:Humans; D007441:Intubation, Gastrointestinal; D007583:Jejunum; D007980:Levodopa / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D009043:Motor Activity; D010300:Parkinson Disease / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D016896:Treatment Outcome
D000978:Antiparkinson Agents; D007980:Levodopa