Background Continuous levodopa delivery by enteral infusion is an alternative to deep brain stimulation and subcutaneous apomorphine to control motor fluctuations and dyskinesia in advanced Parkinson's disease (PD).
Purpose The objective was to describe the efficacy and safety of levodopa duodenal infusion (LDI) in patients with advanced PD.
Materials and methods The authors carried out a retrospective descriptive study in which The authors included patients with PD who started continuous daily LDI through percutaneous endoscopic gastrostomy (PEG) from October 2010 until October 2011. LDI has been introduced in our hospital for advanced PD treatment in patients who have tried all oral medication, have family support and do not have dementia. The patient data were obtained from their clinical histories. The authors evaluated the improvement in the motor fluctuations and dyskinesia and reduction in off-time. The adverse events were assigned to 3 categories: related to the treatment, related to the PEG and related to technical problems with the infusion device.
Results Three patients were included in the study (mean age of 69.7 (range 54-78) years, 33.3% male). The average disease duration was 20.3 (17-23) years and Hoehn & Yahr (H&Y) staging 3-4. LCI was used as monotherapy. Dosing of LCI was adjusted to the needs of each individual patient. The total accumulated follow-up time was 17 months (2-12). All our patients showed an improvement of fluctuations, increased on-time without dyskinesia and a reduction in the duration of the off periods. One of them was in stage 4 on the H&Y scale and improved to stage 3. In terms of complications, there was one due to PEG positioning and failures in the infusion system.
Conclusions LCI is a useful treatment to reduce motor fluctuations and dyskinesia for patients with advanced PD in whom motor fluctuations and dyskinesia were inadequately treated with traditional oral medicines. The procedure was in general well tolerated and complications were related to the infusion system and dopaminergic effects but could easily be managed. Our conclusions were limited by the modest number and size of the study. New evaluations are needed.
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