title: Causes of withdrawal of duodenal levodopa infusion in advanced Parkinson disease.
abstract: OBJECTIVE
  We performed a real-life observation of patients with Parkinson disease (PD) who received duodenal levodopa infusion (DLI) to determine which adverse events caused treatment discontinuation and when such events occurred.
  
  
  METHODS
  All consecutive patients with PD treated at the Carlo Besta Neurological Institute were included. The patients were evaluated at baseline and after DLI at regular intervals. Their motor condition was assessed and adverse events were recorded.
  
  
  RESULTS
  Thirty-five patients with PD (15 men and 20 women) were included. They received DLI implants between October 2007 and September 2013. Four patients died of causes unrelated to the procedure. At the end of the study, 21 patients (60%) were still on treatment. DLI provided efficacious motor control in all patients. Discontinuation was most frequently caused by device- or infusion-related adverse events. Ten patients of the remaining 31 discontinued DLI. There were 2 main causes of withdrawal: stoma infection (4 patients), and worsening of dyskinesias not manageable with infusion reduction (3 patients). In most patients, discontinuations occurred during the first year after implant. Risk of discontinuation was related to age at implant, but no other demographic or clinical variables.
  
  
  CONCLUSIONS
  We identified 2 main causes leading to DLI withdrawal during the first year postimplant and suggest adopting measures to prevent such occurrences. Elderly patients are at higher risk of treatment discontinuation.
authors: From Neurologia I (D.C., L.M.R., A.E.E., F.D.S., C.F.B., A.A.), Istituto Neurologico Carlo Besta, Milano; Istituto di Neurologia (L.M.R., A.E.E., F.D.S., C.F.B., A.A.), Università Cattolica del Sacro Cuore, Milano; and Endoscopia Diagnostica e Chirurgia Endoscopica (M.F.), Istituto Nazionale Tumori, Milano, Italy.
authors: Daniela
authors: D
authors: Calandrella
authors: From Neurologia I (D.C., L.M.R., A.E.E., F.D.S., C.F.B., A.A.), Istituto Neurologico Carlo Besta, Milano; Istituto di Neurologia (L.M.R., A.E.E., F.D.S., C.F.B., A.A.), Università Cattolica del Sacro Cuore, Milano; and Endoscopia Diagnostica e Chirurgia Endoscopica (M.F.), Istituto Nazionale Tumori, Milano, Italy.
authors: Luigi M
authors: LM
authors: Romito
authors: From Neurologia I (D.C., L.M.R., A.E.E., F.D.S., C.F.B., A.A.), Istituto Neurologico Carlo Besta, Milano; Istituto di Neurologia (L.M.R., A.E.E., F.D.S., C.F.B., A.A.), Università Cattolica del Sacro Cuore, Milano; and Endoscopia Diagnostica e Chirurgia Endoscopica (M.F.), Istituto Nazionale Tumori, Milano, Italy.
authors: Antonio E
authors: AE
authors: Elia
authors: From Neurologia I (D.C., L.M.R., A.E.E., F.D.S., C.F.B., A.A.), Istituto Neurologico Carlo Besta, Milano; Istituto di Neurologia (L.M.R., A.E.E., F.D.S., C.F.B., A.A.), Università Cattolica del Sacro Cuore, Milano; and Endoscopia Diagnostica e Chirurgia Endoscopica (M.F.), Istituto Nazionale Tumori, Milano, Italy.
authors: Francesca
authors: F
authors: Del Sorbo
authors: From Neurologia I (D.C., L.M.R., A.E.E., F.D.S., C.F.B., A.A.), Istituto Neurologico Carlo Besta, Milano; Istituto di Neurologia (L.M.R., A.E.E., F.D.S., C.F.B., A.A.), Università Cattolica del Sacro Cuore, Milano; and Endoscopia Diagnostica e Chirurgia Endoscopica (M.F.), Istituto Nazionale Tumori, Milano, Italy.
authors: Caterina F
authors: CF
authors: Bagella
authors: From Neurologia I (D.C., L.M.R., A.E.E., F.D.S., C.F.B., A.A.), Istituto Neurologico Carlo Besta, Milano; Istituto di Neurologia (L.M.R., A.E.E., F.D.S., C.F.B., A.A.), Università Cattolica del Sacro Cuore, Milano; and Endoscopia Diagnostica e Chirurgia Endoscopica (M.F.), Istituto Nazionale Tumori, Milano, Italy.
authors: Massimo
authors: M
authors: Falsitta
authors: From Neurologia I (D.C., L.M.R., A.E.E., F.D.S., C.F.B., A.A.), Istituto Neurologico Carlo Besta, Milano; Istituto di Neurologia (L.M.R., A.E.E., F.D.S., C.F.B., A.A.), Università Cattolica del Sacro Cuore, Milano; and Endoscopia Diagnostica e Chirurgia Endoscopica (M.F.), Istituto Nazionale Tumori, Milano, Italy. alberto.albanese@unicatt.it.
authors: Alberto
authors: A
authors: Albanese
mesh_terms: D000368:Aged; D000978:Antiparkinson Agents / Q000008:administration & dosage / Q000009:adverse effects*; D004386:Duodenum / Q000601:surgery; D005260:Female; D006801:Humans; D015918:Infusion Pumps, Implantable / Q000009:adverse effects*; D007263:Infusions, Parenteral / Q000009:adverse effects*; D007980:Levodopa / Q000008:administration & dosage / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000188:drug therapy*
chemical_list: D000978:Antiparkinson Agents; D007980:Levodopa