title: Long-term response to continuous duodenal infusion of levodopa/carbidopa gel in patients with advanced Parkinson disease: The Barcelona registry.
abstract: BACKGROUND
  Continuous infusion of levodopa/carbidopa intestinal gel (LCIG) is an effective treatment for patients with advanced Parkinson Disease (PD) that cannot be further improved by oral therapy.
  
  
  METHODS
  We conducted an observational, prospective, and multicenter study to collect, in a large sample of PD treated with LCIG, long-term information about the outcome and safety of the treatment. The assessments were performed before LCIG, 1, 3, 6 months after, and ever since, every 6 months.
  
  
  RESULTS
  We studied 72 patients with a mean observation time of 22 months and a maximum of 48 months. During follow-up 28 patients discontinued the treatment, especially for lack of efficacy or adverse events related to the drug. We obtained a significant improvement of motor and non-motor fluctuations, mean off time and some non-motor symptoms. A significant increase in the percentage of time with dyskinesias was found in patients having less than 50% of the day with dyskinesias before LCIG. However, patients having already many dyskinesias before LCIG experienced a significant decrease of the troublesome dyskinesias, meaning that outcomes might be different depending on specific clinical characteristics. Adverse effects were in general minor but one case of intestinal perforation and one of abdominal cellulite were observed.
  
  
  CONCLUSIONS
  We confirmed that LCIG is a very effective treatment option for advanced PD; however considering the findings that dyskinesia can increase and the potential for serious side effects, we suggest the necessity for development of guidelines that better define the profile of responders.
authors.affiliation: Parkinson's Disease and Movement Disorders Unit, Neurology Service, Hospital Clínic, University of Barcelona, Spain; Instituto de Investigaciones Biomédicas August Pi I Sunyer - IDIBAPS, Barcelona, Spain; CIBERNED Carlos III Health Institute, Spain.
authors.forename: Maríateresa
authors.initials: M
authors.lastname: Buongiorno
authors.affiliation: Parkinson's Disease and Movement Disorders Unit, Neurology Service, Hospital Clínic, University of Barcelona, Spain; Instituto de Investigaciones Biomédicas August Pi I Sunyer - IDIBAPS, Barcelona, Spain; CIBERNED Carlos III Health Institute, Spain.
authors.forename: Francesca
authors.initials: F
authors.lastname: Antonelli
authors.affiliation: Parkinson's Disease and Movement Disorders Unit, Neurology Service, Hospital Clínic, University of Barcelona, Spain; Instituto de Investigaciones Biomédicas August Pi I Sunyer - IDIBAPS, Barcelona, Spain; CIBERNED Carlos III Health Institute, Spain.
authors.forename: Ana
authors.initials: A
authors.lastname: Cámara
authors.affiliation: Neurology Service, Institut Municipal d'Investigacio Medica, Hospital del Mar, Autonomous University of Barcelona, Barcelona, Spain.
authors.forename: Victor
authors.initials: V
authors.lastname: Puente
authors.affiliation: Movement Disorders Unit, Department of Neurology, Institut de Recerca Vall d'Hebron, Hospital Universitari Vall d'Hebron, Autonomous University of Barcelona, Barcelona, Spain.
authors.forename: Oriol
authors.initials: O
authors.lastname: de Fabregues-Nebot
authors.affiliation: Movement Disorders Unit, Department of Neurology, Institut de Recerca Vall d'Hebron, Hospital Universitari Vall d'Hebron, Autonomous University of Barcelona, Barcelona, Spain.
authors.forename: Jorge
authors.initials: J
authors.lastname: Hernandez-Vara
authors.affiliation: Neurology Service, Hospital de Bellvitge, University of Barcelona, l'Hospitalet de Llobregat, Spain.
authors.forename: Matilde
authors.initials: M
authors.lastname: Calopa
authors.affiliation: CIBERNED Carlos III Health Institute, Spain; Movement Disorders Unit, Neurology Service, Sant Pau Hospital, Autonomous University of Barcelona, Spain.
authors.forename: Berta
authors.initials: B
authors.lastname: Pascual-Sedano
authors.affiliation: CIBERNED Carlos III Health Institute, Spain; Movement Disorders Unit, Neurology Service, Sant Pau Hospital, Autonomous University of Barcelona, Spain.
authors.forename: Antonia
authors.initials: A
authors.lastname: Campolongo
authors.affiliation: Parkinson's Disease and Movement Disorders Unit, Neurology Service, Hospital Clínic, University of Barcelona, Spain; Instituto de Investigaciones Biomédicas August Pi I Sunyer - IDIBAPS, Barcelona, Spain; CIBERNED Carlos III Health Institute, Spain.
authors.forename: Francesc
authors.initials: F
authors.lastname: Valldeoriola
authors.affiliation: Parkinson's Disease and Movement Disorders Unit, Neurology Service, Hospital Clínic, University of Barcelona, Spain; Instituto de Investigaciones Biomédicas August Pi I Sunyer - IDIBAPS, Barcelona, Spain; CIBERNED Carlos III Health Institute, Spain.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Tolosa
authors.affiliation: CIBERNED Carlos III Health Institute, Spain; Movement Disorders Unit, Neurology Service, Sant Pau Hospital, Autonomous University of Barcelona, Spain; Health Sciences Department, Universitat Oberta de Catalunya, Spain.
authors.forename: Jaime
authors.initials: J
authors.lastname: Kulisevsky
authors.affiliation: Parkinson's Disease and Movement Disorders Unit, Neurology Service, Hospital Clínic, University of Barcelona, Spain; Instituto de Investigaciones Biomédicas August Pi I Sunyer - IDIBAPS, Barcelona, Spain; CIBERNED Carlos III Health Institute, Spain. Electronic address: MJMARTI@clinic.ub.es.
authors.forename: Maria Jose
authors.initials: MJ
authors.lastname: Martí
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000978:Antiparkinson Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology*; D002230:Carbidopa / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology*; D004386:Duodenum; D004409:Dyskinesia, Drug-Induced; D020820:Dyskinesias / Q000188:drug therapy* / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D005782:Gels; D006801:Humans; D007263:Infusions, Parenteral; D007980:Levodopa / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology*; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000150:complications / Q000188:drug therapy*; D012042:Registries; D013030:Spain; D016896:Treatment Outcome
chemical_list: D000978:Antiparkinson Agents; D005782:Gels; D007980:Levodopa; D002230:Carbidopa
keywords: Levodopa/carbidopa intestinal gel; Long-term treatment; Motor fluctuations; Non-motor symptoms; Parkinson disease