title: Intrajejunal levodopa versus conventional therapy in Parkinson disease:  motor and nonmotor effects.
abstract: Seventeen patients with advanced Parkinson disease (PD) were treated with intrajejunal L-dopa infusion (IJL) and compared with a matched group of 9 patients (termed comparator [C]) not given IJL because of funding restriction by primary care trusts (PCTs) in the UK, although considered to be clinically eligible for IJL. Assessments were baseline and follow-up (6 months) with Hoehn and Yahr staging, unified PD rating scale (UPDRS-III and UPDRS-IV), Parkinson disease questionnaire (PDQ-8, quality of life [QoL]) and nonmotor symptom scale (NMSS).Baseline characteristics were comparable between the groups. The IJL-treated group showed highly significant improvements in UPDRS-III (P = 0.005), UPDRS-IV (P = 0.0004), total NMSS score (P = 0.004), and QoL (P = 0.01), whereas the C group showed no change in these parameters. A large effect size of IJL was seen in treated patients for UPDRS-III (1.13), UPDRS-IV (1.52), NMSS score (0.82), and QoL (1.12), whereas continuing conventional treatment registered no effect in C.This study confirms the robust effect of IJL on motor and, in particular, nonmotor symptoms and QoL in advanced PD as described in open-label studies but additionally points to the need for such treatment in those denied this therapy because of centrally dictated funding policies leading to inequalities in health care.
authors: National Parkinson Foundation Centre of Excellence, King's College and Institute of Psychiatry, London, UK.
authors: Prashanth
authors: P
authors: Reddy
authors: Pablo
authors: P
authors: Martinez-Martin
authors: Alexandra
authors: A
authors: Rizos
authors: Anne
authors: A
authors: Martin
authors: Guy C
authors: GC
authors: Faye
authors: Ian
authors: I
authors: Forgacs
authors: Per
authors: P
authors: Odin
authors: Angelo
authors: A
authors: Antonini
authors: K Ray
authors: KR
authors: Chaudhuri
mesh_terms: D000368:Aged; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007583:Jejunum / Q000187:drug effects; D007980:Levodopa / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D009048:Motor Skills / Q000187:drug effects* / Q000502:physiology; D010300:Parkinson Disease / Q000188:drug therapy* / Q000503:physiopathology* / Q000523:psychology; D011788:Quality of Life / Q000523:psychology; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
chemical_list: D007980:Levodopa