Intrajejunal levodopa infusion in Parkinson's disease: a pilot multicenter study of effects on nonmotor symptoms and quality of life.
Switching from oral medications to continuous infusion of levodopa/carbidopa gel reduces motor complications in advanced Parkinson's disease (PD), but effects on nonmotor symptoms (NMSs) are unknown. In this prospective open-label observational study, we report the effects of intrajejunal levodopa/carbidopa gel infusion on NMS in PD based on standard assessments utilizing the nonmotor symptoms scale (NMSS) along with the unified Parkinson's disease rating scale (UPDRS 3 motor and 4 complications) and quality of life (QoL) using the Parkinson's disease questionnaire (PDQ-8). Twenty-two advanced PD patients (mean age 58.6 years, duration of disease 15.3 years) were followed for 6 months. A statistically significant beneficial effect was shown in six of the nine domains of the NMSS: cardiovascular, sleep/fatigue, attention/memory, gastrointestinal, urinary, and miscellaneous (including pain and dribbling) and for the total score of this scale (NMSST) paralleling improvement of motor symptoms (UPDRS 3 motor and 4 complications in "best on" state) and dyskinesias/motor fluctuations. In addition, significant improvements were found using the Parkinson's disease sleep scale (PDSS) and the PDQ-8 (QoL). The improvement in PDQ-8 scores correlated highly significantly with the changes in NMSST, whereas a moderately strong correlation was observed with UPDRS changes. This is the first demonstration that a levodopa-based continuous dopaminergic stimulation is beneficial for NMS and health-related quality of life in PD in addition to the reduction of motor fluctuations and dyskinesias.
Department of Neurology, Central Hospital, Bremerhaven, Germany.
Holger
H
Honig
Angelo
A
Antonini
Pablo
P
Martinez-Martin
Ian
I
Forgacs
Guy C
GC
Faye
Thomas
T
Fox
Karen
K
Fox
Francesca
F
Mancini
Margherita
M
Canesi
Per
P
Odin
K Ray
KR
Chaudhuri
D000368:Aged; D000978:Antiparkinson Agents / Q000008:administration & dosage*; D004185:Disability Evaluation; D004386:Duodenum / Q000187:drug effects* / Q000502:physiology; D020776:Endoscopes, Gastrointestinal; D005260:Female; D006801:Humans; D007391:International Cooperation; D007980:Levodopa / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000188:drug therapy / Q000503:physiopathology / Q000523:psychology; D010865:Pilot Projects; D011446:Prospective Studies; D011788:Quality of Life / Q000523:psychology*; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
D000978:Antiparkinson Agents; D007980:Levodopa