May 2008
Eggert
K., Schrader C, Hahn M, Stamelou M, Rüssmann A, Dengler R, Oertel W, Odin P
Objectives: We report here on the experience with
continuous jejunal levodopa infusion in 13 German parkinsonian patients
who have motor and nonmotor complications despite individually optimized
oral treatment. The tolerability, efficacy, and the need for dose
adjustment of levodopa infusion were followed-up prospectively. Thereby,
we describe clinically relevant details for how to successfully
initiate and handle this new treatment strategy.
Methods: Thirteen patients with advanced Parkinson
disease (PD) who have motor fluctuations and dyskinesia were switched
off their conventional PD medication to continuous levodopa infusion and
followed-up within a maximum period of 12 months.
Results: Time in "off" represented a mean of 50% (±14;
n = 13) of awake time before levodopa infusion and was reduced to a
mean of 11% (±9; n = 11) of awake time after 6 months. Time in "on with
disabling dyskinesias" represented a mean of 17% (±15; n = 13) of awake
time before levodopa infusion and was reduced to a mean of 3% (±6; n=
11) of awake time after 6 months, thereby increasing the time in good
"on" state. A positive effect on nonmotor symptoms (anxiety, sleep
disturbances) was also observed. In most cases, dose adjustment was
required within the first 6 months (predominantly after months 1-3). The
therapy was safe and effective. However, problems with the technical
device were common.
Conclusions: Continuous jejunal levodopa infusion is
an effective and feasible alternative treatment option for patients with
advanced PD who can cope with and tolerate the device.
