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Ledda C, Romagnolo A, Covolo A, Imbalzano G, Montanaro E, Rizzone MG, Artusi CA, Lopiano L, Zibetti M. Effects of dopaminergic therapy on sleep quality in fluctuating Parkinson's disease patients. J Neurol 2024; 271:3625-3630. [PMID: 38607429 DOI: 10.1007/s00415-024-12351-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Revised: 03/24/2024] [Accepted: 03/25/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND Sleep disorders negatively impact quality of life in Parkinson's disease (PD), yet the role of antiparkinsonian drugs on sleep quality is still unclear. We aimed to explore the correlation between sleep dysfunction and dopaminergic therapy in a large cohort of advanced PD patients. METHODS Patients consecutively evaluated for device-aided therapies eligibility were evaluated by means of the PD Sleep Scale (PDSS-2; score ≥ 18 indicates poor sleep quality), and the Epworth Sleepiness Scale (ESS score ≥ 10 indicates excessive daytime sleepiness-EDS). Binary logistic regression analysis, adjusting for age, sex, disease duration, motor impairment, and sleep drugs, was employed to evaluate the association between dopaminergic therapy and PDSS-2 and ESS scores. Analysis of covariance assessed differences in PDSS-2 and ESS scores between patients without DA, and between patients treated with low or high doses of DA (cut-off: DA-LEDD = 180 mg). RESULTS In a cohort of 281 patients, 66.2% reported poor sleep quality, and 34.5% reported EDS. DA treatment demonstrated twofold lower odds of reporting relevant sleep disturbances (OR 0.498; p = 0.035), while DA-LEDD, levodopa-LEDD, total LEDD, and extended-release levodopa were not associated with disturbed sleep. EDS was not influenced by dopaminergic therapy. Patients with DA intake reported significant lower PDSS-2 total score (p = 0.027) and "motor symptoms at night" domain score (p = 0.044). Patients with higher doses of DA showed lower PDSS-2 total score (p = 0.043). CONCLUSION Our study highlights the positive influence of DA add-on treatment on sleep quality in this group of advanced fluctuating PD patients.
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Affiliation(s)
- Claudia Ledda
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Via Cherasco 15, 10126, Turin, Italy
- SC Neurologia 2U, A.O.U. Città della Salute e della Scienza di Torino, Corso Bramante 88, 10126, Turin, Italy
| | - Alberto Romagnolo
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Via Cherasco 15, 10126, Turin, Italy
- SC Neurologia 2U, A.O.U. Città della Salute e della Scienza di Torino, Corso Bramante 88, 10126, Turin, Italy
| | - Anna Covolo
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Via Cherasco 15, 10126, Turin, Italy
- SC Neurologia 2U, A.O.U. Città della Salute e della Scienza di Torino, Corso Bramante 88, 10126, Turin, Italy
| | - Gabriele Imbalzano
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Via Cherasco 15, 10126, Turin, Italy
- SC Neurologia 2U, A.O.U. Città della Salute e della Scienza di Torino, Corso Bramante 88, 10126, Turin, Italy
| | - Elisa Montanaro
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Via Cherasco 15, 10126, Turin, Italy
- SC Neurologia 2U, A.O.U. Città della Salute e della Scienza di Torino, Corso Bramante 88, 10126, Turin, Italy
| | - Mario Giorgio Rizzone
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Via Cherasco 15, 10126, Turin, Italy
- SC Neurologia 2U, A.O.U. Città della Salute e della Scienza di Torino, Corso Bramante 88, 10126, Turin, Italy
| | - Carlo Alberto Artusi
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Via Cherasco 15, 10126, Turin, Italy
- SC Neurologia 2U, A.O.U. Città della Salute e della Scienza di Torino, Corso Bramante 88, 10126, Turin, Italy
| | - Leonardo Lopiano
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Via Cherasco 15, 10126, Turin, Italy
- SC Neurologia 2U, A.O.U. Città della Salute e della Scienza di Torino, Corso Bramante 88, 10126, Turin, Italy
| | - Maurizio Zibetti
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Via Cherasco 15, 10126, Turin, Italy.
- SC Neurologia 2U, A.O.U. Città della Salute e della Scienza di Torino, Corso Bramante 88, 10126, Turin, Italy.
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Advanced Parkinson's Disease Treatment Simplification and Long-Term Outcomes with Levodopa Carbidopa Intestinal Gel: COSMOS Romanian Subanalysis. Brain Sci 2021; 11:brainsci11121566. [PMID: 34942868 PMCID: PMC8699449 DOI: 10.3390/brainsci11121566] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 11/23/2021] [Accepted: 11/24/2021] [Indexed: 12/04/2022] Open
Abstract
The aim of the COmedication Study assessing Mono- and cOmbination therapy with levodopa-carbidopa inteStinal gel (COSMOS) was to assess the use of levodopa/carbidopa intestinal gel (LCIG) as monotherapy in patients with advanced Parkinson’s disease (APD) in routine clinical practice. COSMOS was an international observational study with one cross-sectional visit and retrospective data collection. In Romania, 95 adult patients with APD on LCIG treatment for at least 12 months were enrolled and stratified according to their LCIG therapy after 12 months: monotherapy (without any add-on PD medication), monotherapy with night PD medication and LCIG + add-on medication. Compared to the moment of LCIG initiation, the percentage of patients on monotherapy increased at three months after LCIG initiation and remained constant up to 12 months, when 30.5% of the patients were on LCIG monotherapy and 11.6% were on monotherapy with night medication. “Off” time and “On” time with dyskinesia decreased from LCIG initiation to patient visit in all groups. LCIG monotherapy with or without night medication may provide a simplified treatment option for selected APD patients, with long-term efficacy similar to that of LCIG plus add-on medication.
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Standaert DG, Aldred J, Anca-Herschkovitsch M, Bourgeois P, Cubo E, Davis TL, Iansek R, Kovács N, Pontieri FE, Siddiqui MS, Simu M, Bergmann L, Kukreja P, Robieson WZ, Chaudhuri KR. DUOGLOBE: One-Year Outcomes in a Real-World Study of Levodopa Carbidopa Intestinal Gel for Parkinson's Disease. Mov Disord Clin Pract 2021; 8:1061-1074. [PMID: 34631942 PMCID: PMC8485588 DOI: 10.1002/mdc3.13239] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 03/12/2021] [Accepted: 03/31/2021] [Indexed: 11/09/2022] Open
Abstract
Background Levodopa-carbidopa intestinal gel (LCIG) is an established treatment for improving motor and some non-motor symptoms (NMS) in patients with advanced Parkinson's disease (PD). Prospective long-term data in routine clinical practice are limited. Objective Assess LCIG effectiveness and safety in patients with advanced PD after 12 months during real-world routine clinical practice. Methods Duodopa/Duopa in patients with advanced Parkinson's disease-a global observational study evaluating long-term effectiveness (DUOGLOBE) (NCT02611713) is an ongoing, prospective, multinational, observational study of LCIG-naïve patients treated as part of routine clinical practice; 3 years of follow-up are planned. The primary outcome is the change in patient-reported off time. Other assessments include the Unified Dyskinesia Rating Scale (UDysRS), Non-Motor Symptoms Scale (NMSS), Parkinson's Disease Sleep scale (PDSS-2), Epworth Sleepiness Scale (ESS), health-related quality of life (HR-QoL), caregiver burden, and serious adverse events (SAEs). Outcomes from baseline to month (M) 12 are presented. Results In this 12-month follow-up, patients (N = 195) had baseline characteristics similar to other LCIG studies. Significant improvements (mean change to M12) were observed in off time (-3.9 ± 3.6 hr/day, P < 0.001), dyskinesia assessed using the UDysRS (-9.6 ± 22.5, P < 0.001), NMSS (-23.1 ± 41.4, P < 0.001), sleep and sleepiness symptoms on the PDSS-2 (-6.5 ± 12.2, P < 0.001) and ESS (-1.0 ± 5.7, P < 0.05), HR-QoL (-9.0 ± 21.6, P < 0.001), and caregiver burden (-1.9 ± 6.7, P = 0.008). Overall, 40.5% (n = 79) of patients experienced SAEs; fall (n = 6; 3.1%) and urinary tract infection (n = 6; 3.1%) were SAEs reported in ≥3% of patients. Conclusions These 12-month outcome data show sustained, long-term improvements and support the real-world effectiveness of LCIG in patients with advanced PD. Safety was consistent with previous studies.
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Affiliation(s)
| | | | | | | | - Esther Cubo
- Neurology Department Hospital Universitario Burgos Burgos Spain
| | - Thomas L Davis
- Vanderbilt University Medical Center Nashville Tennessee USA
| | - Robert Iansek
- Kingston Centre, Monash Health Melbourne Victoria Australia
| | | | | | | | - Mihaela Simu
- Victor Babes University of Medicine and Pharmacy Timisoara Romania
| | | | | | | | - K Ray Chaudhuri
- Parkinson's Foundation Centre of Excellence, King's College Hospital, and King's College Institute of Psychiatry, Psychology & Neuroscience London United Kingdom
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Yan J, Liu A, Huang J, Wu J, Shen R, Ma H, Yang J. Pharmacological Interventions for REM Sleep Behavior Disorder in Parkinson's Disease: A Systematic Review. Front Aging Neurosci 2021; 13:709878. [PMID: 34483882 PMCID: PMC8415017 DOI: 10.3389/fnagi.2021.709878] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 07/21/2021] [Indexed: 11/26/2022] Open
Abstract
To review the therapeutic effects of drugs on REM sleep behavior disorder (RBD) in Parkinson's disease (PD) by searching the MEDLINE/PubMed, Embase, Cochrane, and CBM databases. According to the inclusion and exclusion criteria, studies were included after excluding duplicate data. We evaluated the safety and efficacy of pharmacological intervention to improve RBD in patients with Parkinson's disease (PD-RBD). This systematic review mainly describes the drugs that can be used to treat PD-RBD patients. The results have shown that melatonin can be used as the first-line drug for PD-RBD, and clonazepam provides significant improvement on PD-RBD, androtigotine can be used as an alternative drug. However, further large-scale clinical trial studies are still needed to provide the best guidelines for the pharmacological treatment of PD-RBD.
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Affiliation(s)
- Junqiang Yan
- Key Laboratory of Neuromolecular Biology, The First Affiliated Hospital of Henan University of Science and Technology, Luoyang, China.,Department of Neurology, The First Affiliated Hospital, College of Clinical Medicine of Henan University of Science and Technology, Luoyang, China
| | - Anran Liu
- Department of Neurology, The First Affiliated Hospital, College of Clinical Medicine of Henan University of Science and Technology, Luoyang, China
| | - Jiarui Huang
- Department of Neurology, The First Affiliated Hospital, College of Clinical Medicine of Henan University of Science and Technology, Luoyang, China
| | - Jiannan Wu
- Key Laboratory of Neuromolecular Biology, The First Affiliated Hospital of Henan University of Science and Technology, Luoyang, China
| | - Ruile Shen
- Department of Neurology, The First Affiliated Hospital, College of Clinical Medicine of Henan University of Science and Technology, Luoyang, China
| | - Hongxia Ma
- Department of Neurology, The First Affiliated Hospital, College of Clinical Medicine of Henan University of Science and Technology, Luoyang, China
| | - Jianxue Yang
- Key Laboratory of Neuromolecular Biology, The First Affiliated Hospital of Henan University of Science and Technology, Luoyang, China.,School of Nursing, The First Affiliated Hospital of Henan University of Science and Technology, Luoyang, China
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Montanaro E, Romagnolo A, Fabbri M, Artusi CA, Imbalzano G, Rizzone MG, Lopiano L, Zibetti M. Association between sleep disorders and cognitive dysfunctions in non-demented patients with advanced Parkinson's disease. J Neurol 2021; 269:1538-1545. [PMID: 34328543 PMCID: PMC8857104 DOI: 10.1007/s00415-021-10726-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 07/21/2021] [Accepted: 07/24/2021] [Indexed: 11/29/2022]
Abstract
Background Parkinson’s disease (PD) is increasingly recognized as a multidimensional disorder, characterized by several non-motor symptoms, including disturbances of sleep and cognition. Current studies on the relationship between sleep problems and neuropsychological functions, mainly conducted in early to moderate PD patients, outline mixed results. In this study, we analysed the relationship between subjectively reported sleep alterations and cognitive functions in a large cohort of 181 advanced PD patients. Methods All consecutive, non-demented, advanced PD patients candidates for device-aided therapy completed two self-administered sleep questionnaires—the Parkinson’s Disease Sleep Scale (PDSS-2) and the Epworth Sleepiness Scale (ESS)—and underwent a comprehensive battery of neuropsychological tests encompassing five cognitive domains (reasoning, memory, attention, frontal executive functions, and language). Results Patients showed mild to moderate sleep problems (PDSS-2 score: 23.4 ± 1.2) and mild daytime sleepiness (ESS 8.6 ± 5.1). A significant correlation was found between PDSS-2 total score and non-verbal reasoning, as well as attentive skills, executive functions, and language abilities. No correlations were found between sleep measures and memory tests scores. Patients with clinically relevant sleep disturbances performed worse on attention, executive functions, and language. No significant correlations were found between daytime sleepiness and any neuropsychological test. Conclusions In advanced PD patients, sleep disturbances selectively correlate with specific neuropsychological functions and not with short-term memory and consolidation. Even if confirmations by means of longitudinal studies are needed, our observations suggest the importance of considering treatment of sleep disturbances to minimize their potential impact on cognition.
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Affiliation(s)
- Elisa Montanaro
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Via Cherasco 15, 10126, Turin, Italy.,Neurology 2 Unit, A.O.U. Città della Salute e della Scienza di Torino, Corso Bramante 88, 10126, Torino, Italy
| | - Alberto Romagnolo
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Via Cherasco 15, 10126, Turin, Italy. .,Neurology 2 Unit, A.O.U. Città della Salute e della Scienza di Torino, Corso Bramante 88, 10126, Torino, Italy.
| | - Margherita Fabbri
- Department of Neurosciences, Clinical Investigation Center CIC 1436, Parkinson Toulouse Expert Center, NS-Park/FCRIN Network and NeuroToul COEN Center, Toulouse University Hospital, INSERM, University of Toulouse 3, Toulouse, France
| | - Carlo Alberto Artusi
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Via Cherasco 15, 10126, Turin, Italy.,Neurology 2 Unit, A.O.U. Città della Salute e della Scienza di Torino, Corso Bramante 88, 10126, Torino, Italy
| | - Gabriele Imbalzano
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Via Cherasco 15, 10126, Turin, Italy.,Neurology 2 Unit, A.O.U. Città della Salute e della Scienza di Torino, Corso Bramante 88, 10126, Torino, Italy
| | - Mario Giorgio Rizzone
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Via Cherasco 15, 10126, Turin, Italy.,Neurology 2 Unit, A.O.U. Città della Salute e della Scienza di Torino, Corso Bramante 88, 10126, Torino, Italy
| | - Leonardo Lopiano
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Via Cherasco 15, 10126, Turin, Italy.,Neurology 2 Unit, A.O.U. Città della Salute e della Scienza di Torino, Corso Bramante 88, 10126, Torino, Italy
| | - Maurizio Zibetti
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Via Cherasco 15, 10126, Turin, Italy.,Neurology 2 Unit, A.O.U. Città della Salute e della Scienza di Torino, Corso Bramante 88, 10126, Torino, Italy
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Increased orexin A concentrations in cerebrospinal fluid of patients with behavioural variant frontotemporal dementia. Neurol Sci 2021; 43:313-317. [PMID: 33904007 PMCID: PMC8724071 DOI: 10.1007/s10072-021-05250-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 04/10/2021] [Indexed: 11/17/2022]
Abstract
Orexins are hypothalamic neuropeptides that regulate several physiological functions, such as appetite, arousal, cognition, stress, sleep and metabolism. Emerging pieces of evidence suggest an orexinergic dysfunction in several neuropsychiatric disorders, including depression, anxiety and addiction. A syndromic overlap between behavioural variant frontotemporal dementia (bvFTD) and several psychiatric disorders was recently demonstrated. Therefore, we analysed cerebrospinal fluid (CSF) orexin A concentrations of 40 bvFTD and 32 non-demented patients, correlating neuropeptide concentrations with several clinical characteristics. A significant increase of orexin A concentrations was found in bvFTD patients when compared to controls (p<0.001). CSF orexin A concentration showed a correlation with Mini-Mental State Examination scores, drug assumption, history of compulsive behaviour and extrapyramidal signs. Moreover, we found a relationship between CSF markers of neurodegeneration, total tau and Aβ1–42 and CSF orexin A concentrations. Our study provides evidence of an orexinergic dysfunction in bvFTD, correlating with several clinical symptoms. Further larger studies are needed to confirm our data.
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Scarpina F, Bastoni I, Cappelli S, Priano L, Giacomotti E, Castelnuovo G, Molinari E, Tovaglieri IMA, Cornacchia M, Fanari P, Mauro A. Psychological Well-Being in Obstructive Sleep Apnea Syndrome Associated With Obesity: The Relationship With Personality, Cognitive Functioning, and Subjective and Objective Sleep Quality. Front Psychol 2021; 12:588767. [PMID: 33679512 PMCID: PMC7933550 DOI: 10.3389/fpsyg.2021.588767] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 02/01/2021] [Indexed: 12/27/2022] Open
Abstract
Obstructive sleep apnea (OSA) syndrome severely affects psychological well-being. This syndrome frequently occurs in obesity; however, no previous study has investigated the level of psychological well-being in the case of OSA syndrome associated with obesity. In this work, we assessed the level of psychological well-being in fifty-two individuals affected by OSA syndrome and obesity through the Psychological General Well-Being Index. Moreover, we investigated the role of personality, cognitive functioning and attentional capabilities, subjective perception and objective measurement about sleeping, on the subjective perception of psychological well-being. Our sample reported a lower level of psychological well-being; the participants' scores were below the normative cut-off in all components, except for depression symptoms. A lower expression of harm avoidance temperament and a lower level of daily sleepiness predicted a higher level of psychological well-being. Psychological well-being seemed to be severely affected in individuals affected by OSA syndrome and obesity. The temperament and subjective perception of daily alertness and sleepiness, rather than the syndrome severity, seemed to play a crucial role in the individual perception of the psychological well-being.
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Affiliation(s)
- Federica Scarpina
- IRCCS, U.O. di Neurologia e Neuroriabilitazione, Ospedale S. Giuseppe, Istituto Auxologico Italiano, Piancavallo, Italy
- “Rita Levi Montalcini” Department of Neuroscience, University of Turin, Turin, Italy
| | - Ilaria Bastoni
- Laboratorio di Psicologia, IRCCS, Ospedale S. Giuseppe, Istituto Auxologico Italiano, Piancavallo, Italy
| | - Simone Cappelli
- Laboratorio di Psicologia, IRCCS, Ospedale S. Giuseppe, Istituto Auxologico Italiano, Piancavallo, Italy
| | - Lorenzo Priano
- IRCCS, U.O. di Neurologia e Neuroriabilitazione, Ospedale S. Giuseppe, Istituto Auxologico Italiano, Piancavallo, Italy
- “Rita Levi Montalcini” Department of Neuroscience, University of Turin, Turin, Italy
| | - Emanuela Giacomotti
- IRCCS, U.O. di Neurologia e Neuroriabilitazione, Ospedale S. Giuseppe, Istituto Auxologico Italiano, Piancavallo, Italy
| | - Gianluca Castelnuovo
- Laboratorio di Psicologia, IRCCS, Ospedale S. Giuseppe, Istituto Auxologico Italiano, Piancavallo, Italy
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Enrico Molinari
- Laboratorio di Psicologia, IRCCS, Ospedale S. Giuseppe, Istituto Auxologico Italiano, Piancavallo, Italy
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
| | | | - Mauro Cornacchia
- IRCCS, U.O. di Riabilitazione Pneumologica, Ospedale S. Giuseppe, Istituto Auxologico Italiano, Piancavallo, Italy
| | - Paolo Fanari
- IRCCS, U.O. di Riabilitazione Pneumologica, Ospedale S. Giuseppe, Istituto Auxologico Italiano, Piancavallo, Italy
| | - Alessandro Mauro
- IRCCS, U.O. di Neurologia e Neuroriabilitazione, Ospedale S. Giuseppe, Istituto Auxologico Italiano, Piancavallo, Italy
- “Rita Levi Montalcini” Department of Neuroscience, University of Turin, Turin, Italy
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Thakkar S, Fung VSC, Merola A, Rollins M, Soileau MJ, Kovács N. 24-Hour Levodopa-Carbidopa Intestinal Gel: Clinical Experience and Practical Recommendations. CNS Drugs 2021; 35:137-149. [PMID: 33582982 PMCID: PMC7907013 DOI: 10.1007/s40263-020-00782-w] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/05/2020] [Indexed: 12/17/2022]
Abstract
Infusion of levodopa-carbidopa intestinal gel (LCIG; also designated carbidopa-levodopa enteral suspension) for 16 hours is a standard treatment for patients with advanced Parkinson's disease, and clinical observations suggest that 24-hour LCIG infusion may further reduce symptoms. This review provides practical advice on the management of patients transitioning to 24-hour LCIG infusion. We review available clinical data for 24-hour infusion and discuss adjustments to dosing, recommendations for monitoring, and management of patient concerns, based on our clinical experience. Data from multiple studies suggest that LCIG may improve non-motor symptoms. Although few studies have examined 24-hour LCIG infusion, available data indicate that certain patients may benefit from around-the-clock treatment. Studies of 24-hour LCIG infusion are limited by small sample sizes and open-label study designs, which may hamper translation to clinical practice. In our experience, we have found that patients may benefit from 24-hour infusion when reductions in nocturnal symptoms and improvements to quality of sleep are needed. Levodopa-unresponsive freezing of gait or poorly controlled troublesome dyskinesias may also indicate a patient may benefit from 24-hour infusion. Dose adjustments, especially of the nocturnal rate, are typically necessary and, as with 16-hour infusion, patients should be monitored for autonomic dysfunction; overnight wearing off symptoms; weight changes; fluctuations in plasma levels of vitamins B6/B12, folate, and homocysteine; changes in sleep patterns; or worsening of hallucinations, delusions, and/or nightmares. Available data and our clinical experience suggest that 24-hour LCIG may be warranted among selected patients who have poorly controlled nocturnal fluctuations or early morning "off" symptoms.
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Affiliation(s)
- Sandeep Thakkar
- Department of Neuroscience, Hoag Memorial Hospital Presbyterian, 510 Superior Ave, Suite 200A, Newport Beach, CA, 92663, USA.
| | - Victor S. C. Fung
- grid.1013.30000 0004 1936 834XMovement Disorders Unit, Department of Neurology, Westmead Hospital and Sydney Medical School, University of Sydney, Sydney, NSW Australia
| | - Aristide Merola
- grid.412332.50000 0001 1545 0811Department of Neurology, The Ohio State University Wexner Medical Center, Columbus, OH USA
| | | | | | - Norbert Kovács
- grid.9679.10000 0001 0663 9479Department of Neurology, Medical School, University of Pécs, Pécs, Hungary ,MTA-PTE Clinical Neuroimaging MR Research Group, Pécs, Hungary
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9
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Kamel WA, Al-Hashel JY. LCIG in treatment of non-motor symptoms in advanced Parkinson's disease: Review of literature. Brain Behav 2020; 10:e01757. [PMID: 32677345 PMCID: PMC7507541 DOI: 10.1002/brb3.1757] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 05/19/2020] [Accepted: 06/28/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND For managing nonmotor symptoms (NMS) in advanced Parkinson's disease (PD), levodopa-carbidopa intestinal gel (LCIG) infusion is of interest as it shows lesser plasma fluctuations of both drugs as compared to oral levodopa-carbidopa (LC). OBJECTIVES To highlight LCIG effect in NMS among advanced PD patients and appraise the currently available literature. METHODS PubMed screening (till 2020) of 184 articles was done, of which 51 were selected. Among them, 23 original articles relevant to the research question were included, of which 6 were then excluded after careful reading of full articles. The 17 relevant studies of the review provide Grade C level of evidence of efficacy. RESULTS LCIG is beneficial in improving or relieving various NMS especially (mood, cognition/memory, sleep, gastrointestinal symptoms, urinary symptoms, and quality of life questionnaires) in patients with advanced PD. Amelioration of motor functions or direct relations may lead to improvement in NMS PD patients using LCIG. Adverse events noted in patients treated with LCIG include pneumoperitoneum, abdominal pain, stoma infection, reversible peripheral neuropathy, local tube problems, impulse control disorder, and weight loss. Serious adverse events were mostly found to be unrelated to LCIG. CONCLUSIONS LCIG provides an uninterrupted intestinal levodopa infusion by percutaneous endoscopic gastrojejunostomy (PEG-J). It effectively decreases plasma fluctuations of levodopa and reduces motor instability and NMS burden in advanced PD. However, adequate dose modification and individualization of therapy are essential for optimal effect.
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Affiliation(s)
- Walaa A Kamel
- Neurology Department, Ibn-Sina Hospital, Kuwait City, Kuwait.,Neurology Department, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt
| | - Jasem Y Al-Hashel
- Neurology Department, Ibn-Sina Hospital, Kuwait City, Kuwait.,Department of Medicine, Faculty of Medicine, Kuwait University, Kuwait City, Kuwait
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10
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The TANDEM investigation: efficacy and tolerability of levodopa-carbidopa intestinal gel in (LCIG) advanced Parkinson's disease patients. J Neural Transm (Vienna) 2020; 127:881-891. [PMID: 32212015 DOI: 10.1007/s00702-020-02175-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 03/09/2020] [Indexed: 01/18/2023]
Abstract
The TANDEM investigation was carried out in 17 Italian Movement Disorder centers on behalf of a joint initiative of neurologist members of the Italian Academy for Parkinson's disease and Movement Disorders (LIMPE-DISMOV Academy) and gastroenterologist members of the Italian Society of Digestive Endoscopy (SIED) to evaluate the efficacy and tolerability of levodopa-carbidopa intestinal gel (LCIG) in patients with advanced Parkinson's disease (PD) in routine medical care. Motor scores in "ON" and OFF" state (UPDRS-III), complications of therapy (UPDRS-IV), activities of daily living, sleep disorders and quality of life were evaluated at baseline and at two follow-up assessments (FUV1 and FUV2) within the initial 12-month LCIG treatment. In 159 patients (55% males) with a mean age of 69.1 ± 6.6 years and a diagnosis of PD since 13.6 ± 5.5 years, the UPDRS-III total score (in "OFF") decreased from baseline (45.8 ± 13.2) to FUV1 (41.0 ± 17.4; p < 0.001) and FUV2 (40.5 ± 15.5; p < 0.001), the UPDRS-IV total score decreased from baseline (8.8 ± 2.9) to FUV1 (5.1 ± 3.4; p < 0.001) and FUV2 (5.5 ± 3.2; p < 0.001). The percentage of patients exhibiting freezing, dystonia, gait/walking disturbances, falls, pain and sleep disorders was significantly reduced. Twenty-eight device complications were reported and 11 (6.9%) patients prematurely terminated the study. LCIG after 12-month treatment led to sustained improvement of time spent in "OFF", complications of therapy, PD-associated symptoms and sleep disorders. LCIG tolerability was consistent with the established safety profile of LCIG.
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Motor and non-motor outcomes in patients with advanced Parkinson's disease treated with levodopa/carbidopa intestinal gel: final results of the GREENFIELD observational study. J Neurol 2019; 266:2164-2176. [PMID: 31134377 PMCID: PMC6687881 DOI: 10.1007/s00415-019-09337-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 04/18/2019] [Accepted: 04/23/2019] [Indexed: 12/03/2022]
Abstract
Introduction The GREENFIELD observational study assessed the effect of levodopa/carbidopa intestinal gel (LCIG) on motor and non-motor symptoms, and the related impact on patient quality of life and caregiver burden up to 8 years. Methods Final results of a large Italian cohort of patients who started LCIG in routine care between 2007 and 2014 are presented. Comparison between baseline (before LCIG) and follow-up visits on yearly basis (visit 2/3) is reported. Primary endpoint was Unified Parkinson’s Disease Rating Scale (UPDRS-IV) Item 39; secondary endpoints were UPDRS I and II, dyskinesia items, PD Quality of Life Questionnaire-39, Parkinson’s Disease Sleep Scale-2, Gait and Falls Questionnaire, Questionnaire on Impulsive Disorders, and Relative Stress Scale. Results Overall, 145 patients from 14 centers were assessed with a mean time since LCIG start of 2.8 ± 1.7 years at visit 2. The mean UPDRS-IV item 39 score showed significant reductions compared to baseline (mean score 2.0 ± 0.81) at visit 2 (mean score 0.9 ± 0.69; − 55%; p < 0.001) and at visit 3 (mean score 1.0 ± 0.75; − 50%; p < 0.001). At visit 3, significant reductions were observed for dyskinesia duration score (− 28%; p < 0.001), dyskinesia disability (− 40%; p < 0.001), and painful dyskinesia (− 50%; p < 0.001). Overall, 40 (27.6%) patients experienced 49 serious adverse events which were considered related to PEG/J procedure or to device in 16.3% of the cases. Conclusions The results of this study support the long-term efficacy of LCIG on PD symptoms as well as on activities of daily living. The adverse events were consistent with the established LCIG safety profile. Electronic supplementary material The online version of this article (10.1007/s00415-019-09337-6) contains supplementary material, which is available to authorized users.
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Sleep Quality and Levodopa Intestinal Gel Infusion in Parkinson's Disease: A Pilot Study. PARKINSONS DISEASE 2018; 2018:8691495. [PMID: 30515291 PMCID: PMC6236977 DOI: 10.1155/2018/8691495] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 09/08/2018] [Accepted: 10/14/2018] [Indexed: 11/18/2022]
Abstract
Background Sleep problems in patients with advanced Parkinson's disease (PD) have a deleterious impact on quality of life. Objective To assess the effect of levodopa-carbidopa intestinal gel (LCIG) infusion on sleep quality in advanced PD patients. Methods Seven patients participated in a prospective pilot study. Before and after 6 months of LCIG infusion, an overnight polysomnography was performed and the Epworth Sleepiness Scale, fatigue scale, Pittsburgh Sleep Quality Index, Beck Depression Inventory, and the Hamilton Anxiety Rating Scale were administered. Results PSG showed low sleep efficiency. REM sleep without atony was found in 5 patients. After 6 months of LCIG infusion, the percentage of REM sleep decreased as well as the number of arousals especially due to reduction of spontaneous arousals and periodic leg movements during REM sleep, but differences were not statistically significant. Also, scores of all study questionnaires showed a tendency to improve. Conclusion The results show a trend toward an improvement of sleep quality after 6 months of LCIG infusion, although differences as compared to pretreatment values were not statistically significant. The sleep architecture was not modified by LCIG. Further studies with larger study samples are needed to confirm these preliminary findings.
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Merola A, Sturchio A, Hacker S, Serna S, Vizcarra JA, Marsili L, Fasano A, Espay AJ. Technology-based assessment of motor and nonmotor phenomena in Parkinson disease. Expert Rev Neurother 2018; 18:825-845. [PMID: 30269610 DOI: 10.1080/14737175.2018.1530593] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
INTRODUCTION The increasing development and availability of portable and wearable technologies is rapidly expanding the field of technology-based objective measures (TOMs) in neurological disorders, including Parkinson disease (PD). Substantial challenges remain in the recognition of disease phenomena relevant to patients and clinicians, as well as in the identification of the most appropriate devices to carry out these measurements. Areas covered: The authors systematically reviewed PubMed for studies employing technology as outcome measures in the assessment of PD-associated motor and nonmotor abnormalities. Expert commentary: TOMs minimize intra- and inter-rater variability in clinical assessments of motor and nonmotor phenomena in PD, improving the accuracy of clinical endpoints. Critical unmet needs for the integration of TOMs into clinical and research practice are the identification and validation of relevant endpoints for individual patients, the capture of motor and nonmotor activities from an ecologically valid environment, the integration of various sensor data into an open-access, common-language platforms, and the definition of a regulatory pathway for approval of TOMs. The current lack of multidomain, multisensor, smart technologies to measure in real time a wide scope of relevant changes remain a significant limitation for the integration of technology into the assessment of PD motor and nonmotor functional disability.
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Affiliation(s)
- Aristide Merola
- a James J and Joan A Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology , University of Cincinnati , Cincinnati , OH , USA
| | - Andrea Sturchio
- a James J and Joan A Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology , University of Cincinnati , Cincinnati , OH , USA
| | - Stephanie Hacker
- a James J and Joan A Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology , University of Cincinnati , Cincinnati , OH , USA
| | - Santiago Serna
- a James J and Joan A Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology , University of Cincinnati , Cincinnati , OH , USA
| | - Joaquin A Vizcarra
- a James J and Joan A Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology , University of Cincinnati , Cincinnati , OH , USA
| | - Luca Marsili
- a James J and Joan A Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology , University of Cincinnati , Cincinnati , OH , USA
| | - Alfonso Fasano
- b Edmond J. Safra Program in Parkinson's disease and the Morton and Gloria Shulman Movement Disorders Clinic , Toronto Western Hospital, University of Toronto; Krembil Brain Institute , Toronto , ON , Canada
| | - Alberto J Espay
- a James J and Joan A Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology , University of Cincinnati , Cincinnati , OH , USA
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Schrempf W, Fauser M, Wienecke M, Brown S, Maaß A, Ossig C, Otto K, Brandt MD, Löhle M, Schwanebeck U, Graehlert X, Reichmann H, Storch A. Rasagiline improves polysomnographic sleep parameters in patients with Parkinson's disease: a double-blind, baseline-controlled trial. Eur J Neurol 2018; 25:672-679. [PMID: 29322594 DOI: 10.1111/ene.13567] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2017] [Accepted: 01/08/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND PURPOSE The aim was to study the effects of rasagiline on sleep quality in patients with Parkinson's disease (PD) with sleep disturbances. Sleep disorders are common in PD. Rasagiline is widely used in patients with PD, but double-blind polysomnographic trials on its effects on sleep disturbances are missing. METHODS This was a single-center, double-blind, baseline-controlled investigator-initiated clinical trial of rasagiline (1 mg/day) over 8 weeks in patients with PD with sleep disturbances. Blinding was achieved by running a strategic matched placebo parallel group. Co-primary outcome measures were the changes between baseline and end of the treatment period in sleep maintenance/efficiency as assessed by polysomnography and the Parkinson's Disease Sleep Scale Version 2 (PDSS-2) score. RESULTS A total of 20 of 30 patients were randomized to rasagiline (mean ± SD age, 69.9 ± 6.9 years; 10 male; Hoehn-Yahr stage, 1.9 ± 0.8). Compared with baseline, sleep maintenance was significantly increased at the end of the treatment period (relative change normalized to baseline, +16.3 ± 27.9%; P = 0.024, paired two-sided t-test) and a positive trend for sleep efficiency was detected (+12.1 ± 28.6%; P = 0.097). Treatment with rasagiline led to significantly decreased wake time after sleep onset, number of arousals, percentage of light sleep and improved daytime sleepiness as measured by the Epworth Sleepiness Scale. We did not observe changes in the co-primary endpoint PDSS-2 score, and no correlations of polysomnographic sleep parameters or PDSS-2 score with motor function (Unified Parkinson's Disease Rating Scale motor score). Rasagiline was well tolerated with no unexpected adverse events. CONCLUSIONS In patients with PD with sleep disturbances, rasagiline showed beneficial effects on sleep quality as measured by polysomnography. These effects were probably not related to motor improvement or translated into improved overall sleep quality perception by patients.
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Affiliation(s)
- W Schrempf
- Department of Neurology, Technische Universität Dresden, Dresden, Germany.,Interdisciplinary Sleep Laboratory, Technische Universität Dresden, Dresden, Germany
| | - M Fauser
- Department of Neurology, Technische Universität Dresden, Dresden, Germany.,Department of Neurology, University of Rostock, Rostock, Germany
| | - M Wienecke
- Department of Neurology, Technische Universität Dresden, Dresden, Germany.,Interdisciplinary Sleep Laboratory, Technische Universität Dresden, Dresden, Germany
| | - S Brown
- Department of Neurology, Technische Universität Dresden, Dresden, Germany
| | - A Maaß
- Department of Neurology, Technische Universität Dresden, Dresden, Germany
| | - C Ossig
- Department of Neurology, Technische Universität Dresden, Dresden, Germany
| | - K Otto
- Department of Neurology, Technische Universität Dresden, Dresden, Germany
| | - M D Brandt
- Department of Neurology, Technische Universität Dresden, Dresden, Germany.,Interdisciplinary Sleep Laboratory, Technische Universität Dresden, Dresden, Germany
| | - M Löhle
- Department of Neurology, Technische Universität Dresden, Dresden, Germany.,Department of Neurology, University of Rostock, Rostock, Germany.,German Center for Neurodegenerative Diseases (DZNE) Rostock, Rostock, Germany
| | - U Schwanebeck
- Koordinierungszentrum für Klinische Studien (Coordination Center for Clinical Trials), Technische Universität Dresden, Dresden, Germany
| | - X Graehlert
- Koordinierungszentrum für Klinische Studien (Coordination Center for Clinical Trials), Technische Universität Dresden, Dresden, Germany
| | - H Reichmann
- Department of Neurology, Technische Universität Dresden, Dresden, Germany
| | - A Storch
- Department of Neurology, Technische Universität Dresden, Dresden, Germany.,Interdisciplinary Sleep Laboratory, Technische Universität Dresden, Dresden, Germany.,Department of Neurology, University of Rostock, Rostock, Germany.,German Center for Neurodegenerative Diseases (DZNE) Rostock, Rostock, Germany
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