Duodenal Levodopa Infusion Improves Quality of Life in Advanced Parkinson’s DiseaseAntonini A.a · Mancini F.b · Canesi M.a · Zangaglia R.c · Isaias I.U.a · Manfredi L.b · Pacchetti C.c · Zibetti M.d · Natuzzi F.a · Lopiano L.d · Nappi G.c · Pezzoli G.a
aParkinson Institute, Istituti Clinici di Perfezionamento, e bServizio di Neurologia, Clinica San Pio X, Milano, cCentro Parkinson, Istituto Neurologico IRCCS ‘C. Mondino’, Pavia, e dDipartimento di Neuroscienze, Università di Torino, Torino, Italia
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Background: A significant percentage of patients with Parkinson’s disease (PD) continue to experience motor fluctuations and dyskinesias despite the association of dopamine agonists and levodopa with COMT or MAO-B inhibitors. The use of apomorphine infusion is limited by compliance while deep brain stimulation is feasible only for a small number of patients mostly because of age constraints. Objective: To assess prospectively the effectiveness of duodenal levodopa infusion on quality of life as well as motor features in patients with advanced PD. In all but 1 case levodopa infusion was stopped at nighttime. Methods: We report the outcome of 22 PD patients, followed for up to 2 years, who were on continuous duodenal levodopa/carbidopa infusion through percutaneous endoscopic gastrostomy. Results: We found a significant reduction in ‘off’ period duration as well as dyskinesia severity (Unified Parkinson’s Disease Rating Scale part IV, items 33 and 39). There was significant improvement in the 39-item Parkinson’s Disease Quality of Life Questionnaire as well as in the Unified Parkinson’s Disease Rating Scale part II up to the 2-year follow-up. Five patients withdrew: 2 for poor compliance and 3 for adverse events (1 was related to percutaneous endoscopic gastrostomy). Conclusions: These results demonstrate significant clinical improvements in quality of life and activities of daily living consistent with the occurrence of a satisfactory therapeutic response and a reduction in dyskinesia severity.
© 2008 S. Karger AG, Basel
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