Fluctuating functions related to quality of life in advanced Parkinson disease: effects of duodenal levodopa infusion.
OBJECTIVE
To assess fluctuations in quality of life (QoL) and motor performance in patients with advanced Parkinson disease (PD) treated with continuous daytime duodenal levodopa/carbidopa infusion or conventional therapy.


METHODS
Of 18 patients completing a 6-week trial (DIREQT), 12 were followed for up to 6 months and assessed using electronic diaries and the PD Questionnaire-39 (PDQ-39).


RESULTS
During the trial and follow-up, major diurnal fluctuations were observed, especially for hyperkinesia, 'off' time, ability to walk and depression. Duodenal infusion was associated with significantly more favourable outcomes compared with conventional treatment for satisfaction with overall functioning, 'off' time and ability to walk, with improved outcomes with PDQ-39.


CONCLUSIONS
Relative to conventional treatment, infusion therapy may stabilize and significantly improve motor function and patient's QoL. The potential for daily fluctuation in PD symptoms means single measures of treatment effectiveness can result in bias in effect estimates and hence repeated measures are recommended.
Isacson
D
D
Department of Pharmacy, Pharmacoepidemiology and Pharmacoeconomics, Uppsala University, Sweden.
Bingefors
K
K
Kristiansen
I S
IS
Nyholm
D
D
D000368:Aged; D000978:Antiparkinson Agents / Q000008:administration & dosage / Q000009:adverse effects; D018592:Cross-Over Studies; D003866:Depressive Disorder / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology; D018450:Disease Progression; D004386:Duodenum / Q000187:drug effects; D005260:Female; D020233:Gait Disorders, Neurologic / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology; D006801:Humans; D006948:Hyperkinesis / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology; D007980:Levodopa / Q000008:administration & dosage* / Q000009:adverse effects*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009043:Motor Activity; D009069:Movement Disorders / Q000188:drug therapy / Q000503:physiopathology; D010300:Parkinson Disease / Q000188:drug therapy* / Q000503:physiopathology*; D017060:Patient Satisfaction; D011788:Quality of Life / Q000523:psychology*; D018434:Sickness Impact Profile; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
D000978:Antiparkinson Agents; D007980:Levodopa