March 2008
Antonini
A, Mancini F, Canesi M, Zangaglia R, Isaias IU, Manfredi L, Pacchetti C,
Zibetti M, Natuzzi F, Lopiano L, Nappi G, Pezzoli G
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.
