title: Improvement of dyskinesias with L-dopa infusion in advanced Parkinson's disease.
abstract: OBJECTIVE
  We wanted to investigate whether continuous intrajejunal levodopa-carbidopa intestinal gel (LCIG) therapy has an antidyskinetic effect in patients with Parkinson's disease (PD) and troublesome dyskinesias. We also sought to examine the effect of LCIG therapy on motor function and health-related quality of life (HRQoL).
  
  
  METHODS
  This open-label pilot study used a single group pre-post design with follow-up at 6 months. Nine patients with PD who reported to spend at least 3 h per day in on with troublesome dyskinesia were included. The patients were examined at baseline using clinical and self-assessment measures and then switched from peroral/transdermal pharmacotherapy to LCIG therapy. Data collection was repeated 6 months after the pharmaceutical intervention. Nonparametric statistical methods were used for data analyses.
  
  
  RESULTS
  The mean time spent in on with troublesome dyskinesia per day after 6 months of LCIG therapy decreased by 47% (P < 0.05). This observation was paralleled by a 112% increase in mean time spent in on without troublesome dyskinesia (P < 0.01). Patient self-assessment of dyskinesia intensity on the visual analog scale displayed a 90% reduction of mean dyskinesia intensity (P < 0.01) and patients also exhibited less dyskinesia during standardized levodopa tests. Furthermore, we noted improvements in motor function and HRQoL.
  
  
  CONCLUSIONS
  In this pilot study, we found indications that LCIG therapy has a substantial antidyskinetic effect and could be an alternative also for PD patients with dyskinesias as a major symptom. However, further studies with blinded evaluation and larger numbers of patients are warranted to confirm the findings.
authors.affiliation: Department of Clinical Sciences, Neurology, Lund University, Lund, Sweden.
authors.forename: J
authors.identifier: http://orcid.org/0000-0002-2577-8607
authors.initials: J
authors.lastname: Timpka
authors.affiliation: Department of Neurology, Central Hospital, Bremerhaven, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Fox
authors.affiliation: Department of Neurology, Central Hospital, Bremerhaven, Germany.
authors.forename: K
authors.initials: K
authors.lastname: Fox
authors.affiliation: Department of Neurology, Central Hospital, Bremerhaven, Germany.
authors.forename: H
authors.initials: H
authors.lastname: Honig
authors.affiliation: Department of Clinical Sciences, Neurology, Lund University, Lund, Sweden.|Department of Neurology, Central Hospital, Bremerhaven, Germany.
authors.forename: P
authors.initials: P
authors.lastname: Odin
authors.affiliation: National Center of Epidemiology and CIBERNED, Carlos III Institute of Health, Madrid, Spain.
authors.forename: P
authors.initials: P
authors.lastname: Martinez-Martin
authors.affiliation: Parkinson's Disease and Movement Disorders Unit, IRCCS Hospital San Camillo, Venice, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Antonini
authors.affiliation: National Parkinson Foundation Centre of Excellence, King's College Hospital, King's College, London, UK.
authors.forename: K Ray
authors.initials: KR
authors.lastname: Chaudhuri
mesh_terms: D000368:Aged; D000978:Antiparkinson Agents / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D002230:Carbidopa / Q000008:administration & dosage / Q000627:therapeutic use; D020820:Dyskinesias / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D006801:Humans; D007263:Infusions, Parenteral; D007980:Levodopa / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000188:drug therapy*; D010865:Pilot Projects; D011788:Quality of Life
chemical_list: D000978:Antiparkinson Agents; D007980:Levodopa; D002230:Carbidopa
keywords: Parkinson's disease; continuous dopaminergic stimulation; dyskinesias; levodopa-carbidopa intestinal gel; motor complications; movement disorders; quality of life; treatment