title: Intraduodenal levodopa-carbidopa intestinal gel infusion improves both motor performance and quality of life in advanced Parkinson's disease.
abstract: We report the efficacy and adverse effect profile of intraduodenal levodopa-carbidopa intestinal gel (LCIG) infusion from patients treated in a single Australian movement disorder centre. We conducted an open-label, 12 month prospective study of treatment with LCIG in patients with advanced Parkinson's disease in a single tertiary referral hospital unit specialising in movement disorders. Patients with levodopa-responsive, advanced Parkinson's disease with motor fluctuations despite optimal pharmacological treatment were enrolled and underwent a 16 hour daily infusion of LCIG for 12 months. Fifteen participants completed the trial. The mean (± standard deviation) improvement in Unified Parkinson's Disease Rating Scale part III was 37 ± 11%, mean daily "off" period reduced from 6.3 ± 2 to 1.9 ± 2 hours, total daily "on" time increased from 10.2 ± 3 to 13.7 ± 2 hours, "on" period without dyskinesia increased from 4.5 ± 3 to 7.5 ± 5 hours, and 39-item Parkinson's Disease Questionnaire Summary Index score improved by 32.5 ± 35%. The most common adverse event was reversible peripheral neuropathy secondary to vitamin B12 ± B6 deficiency (40%), local tube problems (40%), and impulse control disorder (ICD) (27%). No patient had stoma bleeding or peritonitis. All patients with ICD had a past psychiatric diagnosis of depression with or without anxiety and a higher daily levodopa intake at 6 and 12 months of LCIG infusion. Intraduodenal LCIG improves motor performance, quality of life and daily "on" period. Prior to and during duodenal LCIG infusion, clinicians should monitor for peripheral neuropathy and vitamin B12 and B6 deficiency, as supplementation can reverse peripheral neuropathy. This trial is registered at Clinicaltrials.gov as CT00335153.
authors.affiliation: Movement Disorders Unit, Neurology Department, Westmead Hospital, Corner Darcy and Hawkesbury Road, Westmead, NSW 2145, Australia.
authors.forename: Florence C F
authors.initials: FC
authors.lastname: Chang
authors.affiliation: Gastroenterology Department, Westmead Hospital, Westmead, NSW, Australia.
authors.forename: Vu
authors.initials: V
authors.lastname: Kwan
authors.affiliation: Gastroenterology Department, Westmead Hospital, Westmead, NSW, Australia.
authors.forename: David
authors.initials: D
authors.lastname: van der Poorten
authors.affiliation: Movement Disorders Unit, Neurology Department, Westmead Hospital, Corner Darcy and Hawkesbury Road, Westmead, NSW 2145, Australia.
authors.forename: Neil
authors.initials: N
authors.lastname: Mahant
authors.affiliation: Movement Disorders Unit, Neurology Department, Westmead Hospital, Corner Darcy and Hawkesbury Road, Westmead, NSW 2145, Australia.
authors.forename: Nigel
authors.initials: N
authors.lastname: Wolfe
authors.affiliation: Movement Disorders Unit, Neurology Department, Westmead Hospital, Corner Darcy and Hawkesbury Road, Westmead, NSW 2145, Australia.
authors.forename: Ainhi D
authors.initials: AD
authors.lastname: Ha
authors.affiliation: Movement Disorders Unit, Neurology Department, Westmead Hospital, Corner Darcy and Hawkesbury Road, Westmead, NSW 2145, Australia.
authors.forename: Jane M
authors.initials: JM
authors.lastname: Griffith
authors.affiliation: Movement Disorders Unit, Neurology Department, Westmead Hospital, Corner Darcy and Hawkesbury Road, Westmead, NSW 2145, Australia.
authors.forename: David
authors.initials: D
authors.lastname: Tsui
authors.affiliation: Movement Disorders Unit, Neurology Department, Westmead Hospital, Corner Darcy and Hawkesbury Road, Westmead, NSW 2145, Australia.
authors.forename: Samuel D
authors.initials: SD
authors.lastname: Kim
authors.affiliation: Movement Disorders Unit, Neurology Department, Westmead Hospital, Corner Darcy and Hawkesbury Road, Westmead, NSW 2145, Australia; Sydney Medical School, University of Sydney, Sydney, Australia. Electronic address: vscfung@ozemail.com.au.
authors.forename: Victor S C
authors.initials: VS
authors.lastname: Fung
mesh_terms: D000328:Adult; D000368:Aged; D000978:Antiparkinson Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D001315:Australia; D002230:Carbidopa / Q000008:administration & dosage*; D015259:Dopamine Agents / Q000008:administration & dosage*; D004386:Duodenum; D020820:Dyskinesias / Q000517:prevention & control; D005260:Female; D005782:Gels; D006801:Humans; D007980:Levodopa / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000188:drug therapy* / Q000503:physiopathology / Q000523:psychology; D010523:Peripheral Nervous System Diseases / Q000139:chemically induced / Q000517:prevention & control*; D011446:Prospective Studies; D011597:Psychomotor Performance / Q000187:drug effects*; D011788:Quality of Life
chemical_list: D000978:Antiparkinson Agents; D015259:Dopamine Agents; D005782:Gels; D007980:Levodopa; D002230:Carbidopa
keywords: Impulse control disorder; Levodopa-carbidopa intestinal gel; Parkinson’s disease; Peripheral neuropathy