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Brinker D, Smilowska K, Paschen S, Antonini A, Moro E, Deuschl G. How to Use the New European Academy of Neurology/Movement Disorder Society European Section Guideline for Invasive Therapies in Parkinson's Disease. Mov Disord Clin Pract 2024; 11:209-219. [PMID: 38214401 DOI: 10.1002/mdc3.13962] [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: 09/25/2023] [Revised: 11/28/2023] [Accepted: 12/13/2023] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND The decision to choose invasive treatments for Parkinson's disease (PD) is complex and needs careful consideration. OBJECTIVES Although the recommendations of the European Academy of Neurology/Movement Disorder Society European Section guideline for invasive therapies of PD are useful, the different clinical profiles of people with PD who seek advice for possible invasive therapy need further attention. METHODS AND RESULTS Here we describe 8 clinical standard situations of people with PD unsatisfied with their current oral treatment where invasive therapies may be considered. These are PD patients presenting with the following symptoms: (1) severe motor fluctuations, (2) beginning of levodopa-responsive fluctuations, severe tremor at (3) young or (4) advanced age, (5) impulse control disorders and related behavioral disorders, (6) hallucinations and psychosis, (7) minimal cognitive impairment or mild dementia, and (8) patients in need of palliative care. For some of these conditions, evidence at lower level or simple clinical considerations exist. CONCLUSIONS There are no one-fits-all answers, but physician and patient should discuss each option carefully considering symptom profile, psychosocial context, availability of therapy alternatives, and many other factors. The current paper outlines our proposed approach to these circumstances.
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Affiliation(s)
- Dana Brinker
- Department of Neurology, UKSH, Christian-Albrechts-University Kiel, Kiel, Germany
| | - Katarzyna Smilowska
- Department of Neurology, UKSH, Christian-Albrechts-University Kiel, Kiel, Germany
- Department of Neurology, Regional Specialist Hospital im. Św. Barbary, Sonowiec, Poland
| | - Steffen Paschen
- Department of Neurology, UKSH, Christian-Albrechts-University Kiel, Kiel, Germany
| | - Angelo Antonini
- Parkinson and Movement Disorders Unit, Study Center for Neurodegenerative Diseases (CESNE), Department of Neuroscience, University of Padua, Padua, Italy
| | - Elena Moro
- Grenoble Alpes University, Chu of Grenoble, Division of Neurology, Grenoble Institute of Neurosciences, Grenoble, France
| | - Günther Deuschl
- Department of Neurology, UKSH, Christian-Albrechts-University Kiel, Kiel, Germany
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Gombošová L, Deptová J, Jochmanová I, Svoreňová T, Veseliny E, Zakuciová M, Haň V, Lacková A, Kulcsárová K, Ostrožovičová M, Ventosa JR, Trcková L, Lazúrová I, Škorvánek M. Endoscopic Complications Are More Frequent in Levodopa-Carbidopa Intestinal Gel Treatment via JET-PEG in Parkinson's Disease Patients Compared to Nutritional PEG in Non-Parkinson's Disease Patients. J Clin Med 2024; 13:703. [PMID: 38337398 PMCID: PMC10856619 DOI: 10.3390/jcm13030703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 01/19/2024] [Accepted: 01/23/2024] [Indexed: 02/12/2024] Open
Abstract
Background: To date, no studies comparing complication rates between patients with nutritional percutaneous endoscopic gastrostomy (N-PEG) and Parkinson's disease (PD) patients with percutaneous endoscopic gastro-jejunostomy (JET-PEG) for treatment administration have been published. Our study aimed to compare complication rates and the number of re-endoscopies between N-PEG and JET-PEG patients. Methods: Individuals requiring N-PEG or JET-PEG insertion between 2014 and 2021 were included in this single-center retrospective observational study. Complications were divided into time-related medical and technical complications. Reasons for post-insertion re-endoscopies and their number were also analyzed. Results: Eighty-seven subjects, 47 (54.02%) in JET-PEG group and 40 (45.98%) in the N-PEG group, were included. Early and technical complications were more frequent in JET-PEG vs. N-PEG subjects (70% vs. 10% [p < 0.001], and 54.5% vs. 5.1% [p < 0.001], respectively). The presence of psychiatric disease was associated with a higher number of early complications (p < 0.002). All three types of complications were significantly more frequent in subjects where a healthcare professional did not handle PEG (p < 0.001). Subjects with JET-PEG required a higher number of re-endoscopies compared to the N-PEG group (57.1% vs. 35%, p = 0.05). Conclusions: Complications are significantly more common in individuals with JET-PEG than those with N-PEG, which can be attributed to higher mobility in PD patients.
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Affiliation(s)
- Laura Gombošová
- 2nd Department of Internal Medicine, Faculty of Medicine, University Hospital of Louis Pasteur, Pavol Jozef Šafárik University, 04001 Košice, Slovakia; (E.V.); (M.Z.)
| | - Jana Deptová
- 1st Department of Internal Medicine, Faculty of Medicine, University Hospital of Louis Pasteur, Pavol Jozef Šafárik University, 04001 Košice, Slovakia; (I.J.); (I.L.)
| | - Ivana Jochmanová
- 1st Department of Internal Medicine, Faculty of Medicine, University Hospital of Louis Pasteur, Pavol Jozef Šafárik University, 04001 Košice, Slovakia; (I.J.); (I.L.)
| | - Tatiana Svoreňová
- Department of Neurology, Faculty of Medicine, Pavol Jozef Šafárik University, 04001 Košice, Slovakia; (T.S.); (V.H.); (A.L.); (K.K.); (M.O.); (J.R.V.); (M.Š.)
- Department of Neurology, University Hospital of Louis Pasteur, 04001 Košice, Slovakia;
| | - Eduard Veseliny
- 2nd Department of Internal Medicine, Faculty of Medicine, University Hospital of Louis Pasteur, Pavol Jozef Šafárik University, 04001 Košice, Slovakia; (E.V.); (M.Z.)
| | - Mária Zakuciová
- 2nd Department of Internal Medicine, Faculty of Medicine, University Hospital of Louis Pasteur, Pavol Jozef Šafárik University, 04001 Košice, Slovakia; (E.V.); (M.Z.)
| | - Vladimír Haň
- Department of Neurology, Faculty of Medicine, Pavol Jozef Šafárik University, 04001 Košice, Slovakia; (T.S.); (V.H.); (A.L.); (K.K.); (M.O.); (J.R.V.); (M.Š.)
- Department of Neurology, University Hospital of Louis Pasteur, 04001 Košice, Slovakia;
| | - Alexandra Lacková
- Department of Neurology, Faculty of Medicine, Pavol Jozef Šafárik University, 04001 Košice, Slovakia; (T.S.); (V.H.); (A.L.); (K.K.); (M.O.); (J.R.V.); (M.Š.)
- Department of Neurology, University Hospital of Louis Pasteur, 04001 Košice, Slovakia;
| | - Kristína Kulcsárová
- Department of Neurology, Faculty of Medicine, Pavol Jozef Šafárik University, 04001 Košice, Slovakia; (T.S.); (V.H.); (A.L.); (K.K.); (M.O.); (J.R.V.); (M.Š.)
- Department of Neurology, University Hospital of Louis Pasteur, 04001 Košice, Slovakia;
- Department of Clinical Neurosciences, University Scientific Park MEDIPARK, Pavol Jozef Šafárik University, 04001 Košice, Slovakia
| | - Miriama Ostrožovičová
- Department of Neurology, Faculty of Medicine, Pavol Jozef Šafárik University, 04001 Košice, Slovakia; (T.S.); (V.H.); (A.L.); (K.K.); (M.O.); (J.R.V.); (M.Š.)
- Department of Neurology, University Hospital of Louis Pasteur, 04001 Košice, Slovakia;
| | - Joaquim Ribeiro Ventosa
- Department of Neurology, Faculty of Medicine, Pavol Jozef Šafárik University, 04001 Košice, Slovakia; (T.S.); (V.H.); (A.L.); (K.K.); (M.O.); (J.R.V.); (M.Š.)
- Department of Neurology, University Hospital of Louis Pasteur, 04001 Košice, Slovakia;
- Department of Clinical Neurosciences, University Scientific Park MEDIPARK, Pavol Jozef Šafárik University, 04001 Košice, Slovakia
| | - Lenka Trcková
- Department of Neurology, University Hospital of Louis Pasteur, 04001 Košice, Slovakia;
| | - Ivica Lazúrová
- 1st Department of Internal Medicine, Faculty of Medicine, University Hospital of Louis Pasteur, Pavol Jozef Šafárik University, 04001 Košice, Slovakia; (I.J.); (I.L.)
| | - Matej Škorvánek
- Department of Neurology, Faculty of Medicine, Pavol Jozef Šafárik University, 04001 Košice, Slovakia; (T.S.); (V.H.); (A.L.); (K.K.); (M.O.); (J.R.V.); (M.Š.)
- Department of Neurology, University Hospital of Louis Pasteur, 04001 Košice, Slovakia;
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Modica JS, Déry C, Canissario R, Logigian E, Bonno D, Stanton M, Dupré N, McDermott MP, Bouchard M, Lang AE, Lizarraga KJ. A systematic review of the potential consequences of abnormal serum levels of vitamin B6 in people living with Parkinson's disease. J Neurol Sci 2023; 450:120690. [PMID: 37210937 DOI: 10.1016/j.jns.2023.120690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 04/21/2023] [Accepted: 05/15/2023] [Indexed: 05/23/2023]
Abstract
The prevalences of polyneuropathy and epilepsy are higher in people living with Parkinson's disease (PwPD) when compared to older adults. Vitamin B6 is widely available and affordable. PwPD are at higher risk of having abnormal serum levels of vitamin B6, which are associated with polyneuropathy and epilepsy that are potentially preventable and treatable. Potential contributors to abnormal B6 levels in PwPD include age, dietary habits, vitamin supplement misuse, gastrointestinal dysfunction and complex interactions with levodopa. The literature on the potential consequences of abnormal B6 levels in PwPD is limited by a small number of observational studies focused on polyneuropathy and epilepsy. Abnormal B6 levels have been reported in 60 of 145 PwPD (41.4% relative frequency). Low B6 levels were reported in 52 PwPD and high B6 levels were reported in 8 PwPD. There were 14 PwPD, polyneuropathy and low B6. There were 4 PwPD, polyneuropathy and high B6. There were 4 PwPD, epilepsy and low B6. Vitamin B6 level was low in 44.6% of PwPD receiving levodopa-carbidopa intestinal gel and in 30.1% of PwPD receiving oral levodopa-carbidopa. In almost all studies reporting low B6 in PwPD receiving oral levodopa-carbidopa, the dose of levodopa was ≥1000 mg/day. Rigorous epidemiological studies will clarify the prevalence, natural history and clinical relevance of abnormal serum levels of vitamin B6 in PwPD. These studies should account for diet, vitamin supplement use, gastrointestinal dysfunction, concurrent levels of vitamin B12, folate, homocysteine and methylmalonic acid, formulations and dosages of levodopa and other medications commonly used in PwPD.
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Affiliation(s)
| | - Catherine Déry
- Centre de Recherche du CHU de Québec, Université Laval, Québec, Canada
| | | | - Eric Logigian
- Department of Neurology, University of Rochester, NY, USA
| | - Deana Bonno
- Department of Neurology, University of Rochester, NY, USA
| | | | - Nicolas Dupré
- Centre de Recherche du CHU de Québec, Université Laval, Québec, Canada
| | - Michael P McDermott
- Department of Biostatistics and Computational Biology, University of Rochester, NY, USA
| | - Manon Bouchard
- Centre de Recherche du CHU de Québec, Université Laval, Québec, Canada
| | - Anthony E Lang
- The Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic, University of Toronto, Toronto, Ontario, Canada
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Tokimura R, Ito E, Sugiura Y, Ugawa Y. Nephrotic Syndrome and Atypical Posterior Reversible Encephalopathy Syndrome in a Patient with Parkinson's Disease. Intern Med 2022; 61:2061-2065. [PMID: 34924463 PMCID: PMC9334256 DOI: 10.2169/internalmedicine.8746-21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 59-year-old man with advanced Parkinson's disease treated using levodopa-carbidopa intestinal gel (LCIG) presented with leg edema, hypoalbuminemia, and proteinuria at 1 year after the treatment. He subsequently developed a generalized tonic-clonic seizure, and brain magnetic resonance imaging indicated vasogenic edema in the white matter of the left frontal subcortex. He was diagnosed with nephrotic syndrome (NS) and atypical posterior reversible encephalopathy syndrome (PRES). LCIG cessation and corticosteroid treatment improved the NS. To our knowledge, this is the first case report of NS and atypical PRES in patients with Parkinson's disease. Patients being treated with LCIG should be closely monitored for NS.
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Affiliation(s)
- Ryo Tokimura
- Department of Neurology, National Hospital Organization Fukushima National Hospital, Japan
- Department of Neurology, The University of Tokyo Hospital, Japan
| | - Eiichi Ito
- Department of Neurology, National Hospital Organization Fukushima National Hospital, Japan
| | - Yoshihiro Sugiura
- Department of Neurology, National Hospital Organization Fukushima National Hospital, Japan
| | - Yoshikazu Ugawa
- Department of Human Neurophysiology, Fukushima Medical University, Japan
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Blaise AS, Cuvelier E, Carrière N, Devos D, Moreau F, Defebvre L, Mutez E. Use of levodopa-carbidopa intestinal gel to treat patients with multiple system atrophy. Parkinsonism Relat Disord 2022; 100:41-44. [PMID: 35716627 DOI: 10.1016/j.parkreldis.2022.05.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 05/14/2022] [Accepted: 05/19/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Levodopa-carbidopa intestinal gel (LCIG) is an effective treatment for late-stage Parkinson's disease (PD) but had not been evaluated in levodopa-responsive patients with the parkinsonian variant of multiple system atrophy (MSA-P) and motor fluctuations. We aimed to assess the safety of LCIG in MSA-P patients. METHODS In a retrospective, single-center study, we analyzed clinical and treatment-related data for all patients with MSA-P or PD treated with LCIG between December 2004 and November 2017. Adverse events (AEs) were classified into three classes: AEs related to gastrointestinal effects or to the PEG-J procedure, AEs related to the device, and AEs related to the pharmacological effect of LCIG. RESULTS 7 MSA-P and 63 PD patients had been treated with LCIG for a median [interquartile range] period of 31 [16;43] and 19 [8;45] months, respectively. There were no significant intergroup differences in safety. Enteral nutrition was introduced at the same time as LCIG treatment in 4 (57%) MSA-P patients. In the MSA-P and PD groups, LCIG was associated with a better Global Clinical Impression score and discontinuation of oral anti-parkinsonian drugs (in 43% and 27% of cases, respectively). CONCLUSIONS LCIG treatment is feasible in MSA-P patients with severe motor complications. The safety profile is similar to that seen in PD.
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Affiliation(s)
- A S Blaise
- CHU Lille, Neurology and Movement Disorders Department, F-59000, Lille, France.
| | - E Cuvelier
- CHU Lille, Institut de Pharmacie, F-59000, Lille, France; Univ. Lille, CHU Lille, ULR 7365 - GRITA - Groupe de Recherche sur les formes Injectables et les Technologies Associées, F-59000, Lille, France
| | - N Carrière
- CHU Lille, Neurology and Movement Disorders Department, F-59000, Lille, France; Univ. Lille, INSERM, CHU Lille, UMR-S1172, Lille Neurosciences & Cognition, F-59000, Lille, France
| | - D Devos
- CHU Lille, Neurology and Movement Disorders Department, F-59000, Lille, France; Univ. Lille, INSERM, CHU Lille, UMR-S1172, Lille Neurosciences & Cognition, F-59000, Lille, France
| | - F Moreau
- CHU Lille, Institut de Pharmacie, F-59000, Lille, France
| | - L Defebvre
- CHU Lille, Neurology and Movement Disorders Department, F-59000, Lille, France; Univ. Lille, INSERM, CHU Lille, UMR-S1172, Lille Neurosciences & Cognition, F-59000, Lille, France
| | - E Mutez
- CHU Lille, Neurology and Movement Disorders Department, F-59000, Lille, France; Univ. Lille, INSERM, CHU Lille, UMR-S1172, Lille Neurosciences & Cognition, F-59000, Lille, France
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Majali MA, Sunnaa M, Chand P. Emerging Pharmacotherapies for Motor Symptoms in Parkinson's Disease. J Geriatr Psychiatry Neurol 2021; 34:263-273. [PMID: 34219526 DOI: 10.1177/08919887211018275] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Parkinson's disease (PD) is the second commonest neurodegenerative disorder in the older adult and is characterized by progressive disabling motor symptoms of bradykinesia, tremor, rigidity, postural instability and also non motor symptoms that affect quality of life. The pharmacotherapy of PD consists of oral, transdermal, and subcutaneous medications, as well as invasive advanced therapies at later stages of the disease. PD medications are often started as monotherapy but with the progression of the illness often there is a need to add more medications and frequently comprises of a challenging polypharmacotherapy. Adverse effects of pharmacotherapy often add to the problems of adequate treatment. Patients and physicians have to prioritize treatment goals on the most disabling symptoms and the safest and most effective treatments. Almost every year newer medications and modes of delivery continue to be researched and added to the therapeutic armamentarium. This review article outlines existing and emerging pharmacotherapies for motor symptoms in PD.
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Affiliation(s)
- Mohammad Al Majali
- Department Of Neurology, 12274St Louis University School of Medicine, Spring, St Louis, MO, USA
| | - Michael Sunnaa
- Department Of Neurology, 12274St Louis University School of Medicine, Spring, St Louis, MO, USA
| | - Pratap Chand
- Department Of Neurology, 12274St Louis University School of Medicine, Spring, St Louis, MO, USA
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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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