title: Polyneuropathy while on duodenal levodopa infusion in Parkinson's disease patients: we must be alert.
abstract: Some reports have emerged describing the occurrence of Guillain-Barré syndrome and polyneuropathy related to vitamin B(12) deficiency in some patients with Parkinson's disease (PD) treated with continuous duodenal levodopa infusion. We describe five PD patients who developed axonal polyneuropathy and vitamin B(12) deficiency while on treatment with duodenal levodopa infusion, review other cases reported in the literature, discuss potential etiologic factors, and suggest a possible algorithm for the management and prevention of this complication. One case of Guillain-Barré syndrome and at least 12 cases of polyneuropathy related to vitamin B(12) deficiency have been reported in PD patients treated with duodenal levodopa infusion. Levodopa gel infusion may induce a decrease in vitamin B(12) levels, leading to peripheral neuropathy. Additional pathogenetic mechanisms include alterations related to the metabolism of L: -dopa, abnormal L: -dopa absorption, and direct neurotoxicity of L: -dopa at high doses. Vitamin B(12) supplementation may need to be considered in PD patients on duodenal levodopa infusion therapy. Vitamin B(12) deficiency in patients on duodenal levodopa infusion therapy may be more frequent than the published data suggest. We must be alert.
authors.affiliation: Section of Neurology, Hospital A. Marcide, C/San Pedro Leixa s/n, 15405 Ferrol, Spain. diegosangar@yahoo.es
authors.forename: Diego
authors.initials: D
authors.lastname: Santos-García
authors.forename: Raúl
authors.initials: R
authors.lastname: de la Fuente-Fernández
authors.forename: Francesc
authors.initials: F
authors.lastname: Valldeoriola
authors.forename: Antonio
authors.initials: A
authors.lastname: Palasí
authors.forename: Fátima
authors.initials: F
authors.lastname: Carrillo
authors.forename: Mónica
authors.initials: M
authors.lastname: Grande
authors.forename: Pablo
authors.initials: P
authors.lastname: Mir
authors.forename: Oriol
authors.initials: O
authors.lastname: De Fabregues
authors.forename: Jordi
authors.initials: J
authors.lastname: Casanova
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D004386:Duodenum / Q000187:drug effects / Q000378:metabolism; D005260:Female; D006801:Humans; D007263:Infusions, Parenteral; D007980:Levodopa / Q000008:administration & dosage* / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000097:blood / Q000188:drug therapy*; D011115:Polyneuropathies / Q000097:blood / Q000139:chemically induced* / Q000175:diagnosis*; D014806:Vitamin B 12 Deficiency / Q000097:blood / Q000139:chemically induced / Q000175:diagnosis
chemical_list: D007980:Levodopa