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Balestrino R, Martone T, Toffoli M, Montanaro E, Fabbri M, Artusi CA, Romagnolo A, Zibetti M, Rizzone M, Goldwurm S, Lopiano L, Schapira AHV. Levodopa-carbidopa intestinal gel infusion (LCIG) in Parkinson disease with genetic mutations. Neurol Sci 2024; 45:1489-1497. [PMID: 37926749 DOI: 10.1007/s10072-023-07173-1] [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: 03/16/2023] [Accepted: 10/30/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND Levodopa-carbidopa intestinal gel infusion (LCIG) is a therapeutic option for advanced Parkinson disease (PD) patients with troublesome motor complications, unresponsive to conventional oral treatment. There is some evidence to suggest that the genetic background may influence the clinical presentation and rate of progression of PD. Whether the genetic background influences the outcome of device-assisted therapies is currently debated. Some studies have investigated the effectiveness of deep brain stimulation (DBS) in PD patients with different genetic background, while evidence is lacking regarding LCIG. METHODS A cohort of LCIG patients underwent genetic testing. The motor and neuropsychological outcomes of LCIG were retrospectively analyzed. RESULTS Fifty-six patients were analyzed, nine of them (15%) had at least one mutation/variant in a PD-associated gene: five GBA1, two SNCA, one LRRK2, one PRKN; 13 (23%) carried the BDNF Val66Met polymorphism. The mean duration of follow-up was 4.9 ± 2.6 years. There were no significant differences in motor or neuropsychological outcomes between patients with and without these gene mutations/variants. No cognitive worsening was observed at follow-up among GBA-PD patients, and they responded well to LCIG in terms of motor symptoms. CONCLUSIONS Overall, we observed a significant benefit in terms of motor complications in our cohort, including patients carrying genetic mutations/variants. Due to the small sample and limited number of patients carrying genetic mutations/variants, no definitive conclusions can be drawn yet on the genotype impact on LCIG outcome. A careful selection of patients, regardless of the genetic background, is pivotal for an optimal outcome of LCIG.
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Affiliation(s)
- R Balestrino
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy.
- Neurology 2 Unit, A.O.U., Città Della Salute E Della Scienza Di Torino, Corso Bramante 88, 10124, Turin, Italy.
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London, UK.
- Department of Neurosurgery and Gamma Knife Radiosurgery, IRCCS San Raffaele Scientific Institute, Milan, Italy.
- Neurology and Neurorehabiliation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
- Vita-Salute San Raffaele University, Milan, Italy.
| | - T Martone
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy
| | - M Toffoli
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London, UK
| | - E Montanaro
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy
- Neurology 2 Unit, A.O.U., Città Della Salute E Della Scienza Di Torino, Corso Bramante 88, 10124, Turin, Italy
| | - M Fabbri
- Department of Neurosciences, Clinical Investigation Center 1436, NS-Park/FCRIN Network and NeuroToul COEN Center, Toulouse University Hospital, INSERM, University of Toulouse 3, Parkinson Toulouse Expert Center, Toulouse, France
| | - C A Artusi
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy
- Neurology 2 Unit, A.O.U., Città Della Salute E Della Scienza Di Torino, Corso Bramante 88, 10124, Turin, Italy
| | - A Romagnolo
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy
- Neurology 2 Unit, A.O.U., Città Della Salute E Della Scienza Di Torino, Corso Bramante 88, 10124, Turin, Italy
| | - M Zibetti
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy
- Neurology 2 Unit, A.O.U., Città Della Salute E Della Scienza Di Torino, Corso Bramante 88, 10124, Turin, Italy
| | - M Rizzone
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy
- Neurology 2 Unit, A.O.U., Città Della Salute E Della Scienza Di Torino, Corso Bramante 88, 10124, Turin, Italy
| | - S Goldwurm
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy
| | - L Lopiano
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy
- Neurology 2 Unit, A.O.U., Città Della Salute E Della Scienza Di Torino, Corso Bramante 88, 10124, Turin, Italy
| | - A H V Schapira
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London, UK
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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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3
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Rinaldi D, Imbalzano G, Galli S, Bianchini E, Ledda C, De Carolis L, Zibetti M, Lopiano L, Pontieri FE, Artusi CA. The impact of dysphagia in Parkinson's disease patients treated with levodopa/carbidopa intestinal gel. Parkinsonism Relat Disord 2023; 109:105368. [PMID: 36933499 DOI: 10.1016/j.parkreldis.2023.105368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 03/06/2023] [Accepted: 03/12/2023] [Indexed: 03/16/2023]
Abstract
BACKGROUND Dysphagia is common in advanced phases of Parkinson disease (PD), and is a risk factor for aspiration pneumonia. Nonetheless, dysphagia has been poorly investigated in PD patients treated with levodopa-carbidopa intestinal gel (LCIG). We aimed to analyze the impact of dysphagia on mortality in LCIG treated patients and its relationship with other PD disability milestones. METHODS We retrospectively evaluated 95 consecutive PD patients treated with LCIG. Kaplan-Meier and log-rank test were used to compare mortality in patients with dysphagia from others. Cox regression was used to estimate the impact of dysphagia, age, disease duration, and Hoehn and Yahr (H&Y) on mortality in the entire cohort. Finally, univariate and multivariate regression analyses were used to estimate the association between dysphagia and age, disease duration, H&Y, hallucinations, and dementia. RESULTS A significantly higher mortality rate was observed in patients with dysphagia. In the Cox model, dysphagia was the only feature significantly associated with mortality (95%CI 2.780-20.609; p < 0.001). Univariate analyses showed a significant correlation between dysphagia and dementia (OR: 0.387; p:0.033), hallucinations (OR: 0.283; p:0.009), and H&Y score (OR: 2.680; p < 0.001); in the multivariate analysis, only the H&Y stage was associated with the presence of dysphagia (OR: 2.357; p:0.003). CONCLUSION Dysphagia significantly increased the risk of death in our cohort of LCIG-treated patients, independently from other relevant features such as age, disease duration, dementia, and hallucinations. These findings support the management of this symptom as a priority in the advanced PD stages, even in people treated with LCIG.
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Affiliation(s)
- Domiziana Rinaldi
- Dipartimento di Neuroscienze, Salute Mentale e Organi di Senso, Sapienza Università di Roma, Via di Grottarossa, 1035-00189, Roma, Italy; Fondazione Santa Lucia, IRCCS, Rome, Italy
| | - Gabriele Imbalzano
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy; SC Neurologia 2U, AOU City of Health and Science, Turin, Italy
| | - Silvia Galli
- Dipartimento di Neuroscienze, Salute Mentale e Organi di Senso, Sapienza Università di Roma, Via di Grottarossa, 1035-00189, Roma, Italy
| | - Edoardo Bianchini
- Dipartimento di Neuroscienze, Salute Mentale e Organi di Senso, Sapienza Università di Roma, Via di Grottarossa, 1035-00189, Roma, Italy
| | - Claudia Ledda
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy; SC Neurologia 2U, AOU City of Health and Science, Turin, Italy
| | - Lanfranco De Carolis
- Dipartimento di Neuroscienze, Salute Mentale e Organi di Senso, Sapienza Università di Roma, Via di Grottarossa, 1035-00189, Roma, Italy
| | - Maurizio Zibetti
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy; SC Neurologia 2U, AOU City of Health and Science, Turin, Italy
| | - Leonardo Lopiano
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy; SC Neurologia 2U, AOU City of Health and Science, Turin, Italy
| | - Francesco Ernesto Pontieri
- Dipartimento di Neuroscienze, Salute Mentale e Organi di Senso, Sapienza Università di Roma, Via di Grottarossa, 1035-00189, Roma, Italy; Fondazione Santa Lucia, IRCCS, Rome, Italy
| | - Carlo Alberto Artusi
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy; SC Neurologia 2U, AOU City of Health and Science, Turin, Italy.
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Abusrair AH, Elsekaily W, Bohlega S. Tremor in Parkinson's Disease: From Pathophysiology to Advanced Therapies. Tremor Other Hyperkinet Mov (N Y) 2022; 12:29. [PMID: 36211804 PMCID: PMC9504742 DOI: 10.5334/tohm.712] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 08/26/2022] [Indexed: 11/22/2022] Open
Abstract
Background Tremor is one of the most prevalent symptoms in Parkinson's Disease (PD). The progression and management of tremor in PD can be challenging, as response to dopaminergic agents might be relatively poor, particularly in patients with tremor-dominant PD compared to the akinetic/rigid subtype. In this review, we aim to highlight recent advances in the underlying pathogenesis and treatment modalities for tremor in PD. Methods A structured literature search through Embase was conducted using the terms "Parkinson's Disease" AND "tremor" OR "etiology" OR "management" OR "drug resistance" OR "therapy" OR "rehabilitation" OR "surgery." After initial screening, eligible articles were selected with a focus on published literature in the last 10 years. Discussion The underlying pathophysiology of tremor in PD remains complex and incompletely understood. Neurodegeneration of dopaminergic neurons in the retrorubral area, in addition to high-power neural oscillations in the cerebello-thalamo-cortical circuit and the basal ganglia, play a major role. Levodopa is the first-line therapeutic option for all motor symptoms, including tremor. The addition of dopamine agonists or anticholinergics can lead to further tremor reduction. Botulinum toxin injection is an effective alternative for patients with pharmacological-resistant tremor who are not seeking advanced therapies. Deep brain stimulation is the most well-established advanced therapy owing to its long-term efficacy, reversibility, and effectiveness in other motor symptoms and fluctuations. Magnetic resonance-guided focused ultrasound is a promising modality, which has the advantage of being incisionless. Cortical and peripheral electrical stimulation are non-invasive innovatory techniques that have demonstrated good efficacy in suppressing intractable tremor.
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Affiliation(s)
- Ali H. Abusrair
- Department of Clinical Neurosciences, Faculty of Medicine, University of Calgary, Calgary, AB, Canada
- Division of Neurology, Department of Internal Medicine, Qatif Health Network, Qatif, Saudi Arabia
| | - Walaa Elsekaily
- College of Medicine, AlFaisal University, Riyadh, Saudi Arabia
| | - Saeed Bohlega
- Movement Disorders Program, Neurosciences Centre, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
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Frequency of adverse events in Levodopa‐carbidopa intestinal gel treatment: A retrospective real life study. BRAIN DISORDERS 2022. [DOI: 10.1016/j.dscb.2022.100044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Long-term safety, discontinuation and mortality in an Italian cohort with advanced Parkinson's disease on levodopa/carbidopa intestinal gel infusion. J Neurol 2022; 269:5606-5614. [PMID: 35876875 PMCID: PMC9309989 DOI: 10.1007/s00415-022-11269-7] [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: 04/01/2022] [Revised: 07/02/2022] [Accepted: 07/04/2022] [Indexed: 11/26/2022]
Abstract
Introduction Levodopa/carbidopa intestinal gel (LCIG) is an effective treatment in patients with advanced Parkinson’s disease (PD) with consolidated evidence of clinical efficacy. However, only few studies have assessed long-term safety, causes of discontinuation, mortality, and relative predictors. Methods We conducted a retrospective analysis of 79 PD patients treated with LCIG between 2005 and 2020 in two Italian Neurological Centers, recording all adverse events (AEs), including weight loss (WL). Kaplan–Meier curve was used to estimate the time to discontinuation and survival. Cox proportional hazard model was employed to identify predictors of discontinuation and mortality, while Pearson’s correlation was used to analyze predictors of WL. Results The average follow-up was 47.7 ± 40.5 months and the median survival from disease onset was 25 years. There were three cases of polyradiculoneuropathy Guillain–Barre syndrome-like, all occurred in the early years of LCIG treatment. Twenty-five patients died (32%), 18 on LCIG (including one suicide) and seven after discontinuation. The mean WL was 3.62 ± 7.5 kg, which correlated with levodopa dose at baseline (p = 0.002), levodopa equivalent daily dose (LEDD) baseline (p = 0.017) and off-duration (p = 0.0014), but not dyskinesia. Peristomal complications emerged as a negative predictor of discontinuation (p = 0.008). Conclusions LCIG has a relatively satisfactory long-term safety profile and efficacy and a relatively low rate of discontinuation. Peristomal complications may represent a predictor of longer duration of therapy. According to the mortality analysis, LCIG patients show a long lifespan. Delaying the initiation of LCIG does not affect the sustainability of LCIG therapy. Supplementary Information The online version contains supplementary material available at 10.1007/s00415-022-11269-7.
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7
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Neri M, Sensi M. Reply to the correspondence: "Looking back the importance of genetics in a patient with Parkinson disease and deep brain stimulation", by Salles et al. Parkinsonism Relat Disord 2022; 99:99-100. [PMID: 35641421 DOI: 10.1016/j.parkreldis.2022.05.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 05/23/2022] [Accepted: 05/23/2022] [Indexed: 11/17/2022]
Affiliation(s)
- Marcella Neri
- Unit of Medical Genetics, Department of Medical Sciences, University of Ferrara, Ferrara, Italy.
| | - Mariachiara Sensi
- Department of Neuroscience and Rehabilitation, Azienda Ospedaliera-Universitaria S. Anna, Ferrara, Italy
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Ulivelli M, Bezzini D, Kundisova L, Grazi I, Battaglia MA, Nante N, Rossi S. Mortality of Parkinson's disease in Italy from 1980 to 2015. Neurol Sci 2022; 43:3603-3611. [PMID: 35094172 DOI: 10.1007/s10072-021-05854-3] [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: 11/06/2021] [Accepted: 12/25/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate mortality for Parkinson's disease (PD) in Italy during a long time period (1980-2015) and to discuss the role of possible general and specific influencing factors. METHODS Based on mortality data provided by the Italian National Institute of Statistics, sex- and age-specific crude mortality rates were computed, for the whole country and for its main geographical sub-areas. Rates were standardized using both direct (annual mortality rates AMRs) and indirect (standardized mortality rates SMRs) methods. SMRs were used to evaluate geographical differences, whereas AMRs and joinpoint linear regression analysis to study mortality trends. RESULTS Considering the entire period, highest mortality rates were observed in males (AMR/100,000: 9.0 in males, 5.25 in females), in North-West and Central Italy (SMR > 100). Overall PD mortality decreased from mid-eighties onwards and then rapidly reversed the trend in the period 1998-2002, rising up to a maximum in 2015, with some differences according to sex and geographical areas. CONCLUSIONS Several factors may have contributed to the rapid inversion of decreasing trend in mortality observed in the last part of XX century. Possible explanations of this rising trend are related to the increasing burden of PD (especially in males and in certain Italian regions), caused by different factors as population aging, physiological prevalence rise due to incidence exceeding mortality, and growing exposure to environmental or occupational risk factors. In addition, the accuracy of death certificate compilation could account for geographical differences and for the temporal trend. The role of levodopa and recently introduced dopaminergic drugs is also discussed.
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Affiliation(s)
- Monica Ulivelli
- Department of Medicine, Surgery and Neuroscience, Unit of Neurology and Clinical Neurophysiology, Policlinico Le Scotte, University of Siena, Siena, Italy
| | - Daiana Bezzini
- Department of Life Sciences, University of Siena, Siena, Italy.
| | - Lucia Kundisova
- Postgradual School of Public Health, University of Siena, Siena, Italy
| | - Ilaria Grazi
- Department of Medicine, Surgery and Neuroscience, Unit of Neurology and Clinical Neurophysiology, Policlinico Le Scotte, University of Siena, Siena, Italy
| | - Mario Alberto Battaglia
- Department of Life Sciences, University of Siena, Siena, Italy.,Research Department, Italian Multiple Sclerosis Foundation, Genoa, Italy
| | - Nicola Nante
- Postgradual School of Public Health, University of Siena, Siena, Italy.,Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - Simone Rossi
- Department of Medicine, Surgery and Neuroscience, Unit of Neurology and Clinical Neurophysiology, Policlinico Le Scotte, University of Siena, Siena, Italy
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Viljaharju V, Mertsalmi T, Pauls KAM, Koivu M, Eerola-Rautio J, Udd M, Pekkonen E. Single-Center Study of 103 Consecutive Parkinson's Disease Patients with Levodopa-Carbidopa Intestinal Gel. Mov Disord Clin Pract 2022; 9:60-68. [PMID: 35005066 DOI: 10.1002/mdc3.13361] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 09/13/2021] [Accepted: 09/29/2021] [Indexed: 11/06/2022] Open
Abstract
Background Levodopa-carbidopa intestinal gel (LCIG) effectively reduces off time and dyskinesia and increases on time in advanced Parkinson's disease (PD). However, patients with LCIG-infusion experience frequent complications and some discontinue treatment early on. Objectives The objectives of this study were to find predictive factors for early dropout from the LCIG infusion, analyze the treatment burden on the tertiary health care system, and explore changes in medication during the LCIG treatment. Methods LCIG-infusion was administrated to 103 patients between July 2006 and May 2020 at the Helsinki University Hospital, accumulating 350 years of follow-up data. We evaluated, retrospectively, changes in medication during treatment, discontinuation of the infusion, and adverse events from the patient records. Results Living alone was a predictive factor for early dropout (OR = 3.88; 95% CI = 1.03-14.66; P = 0.045). The treatment burden on the tertiary health care system increased after the initiation of LCIG infusion mostly because of common complications related to the infusion system (median change of in- and out-patient visits +1, P = 0.03). Mean levodopa equivalent daily dose (LEDD) rose from baseline to 6 months (1246.7 vs. 1684.9, P = 0.001) and stabilized thereafter. Patients commonly switched from "polypharmacy" to "LCIG-only" or "LCIG + oral levodopa" medication-groups during long-term treatment. Conclusions Recurrent complications related to the infusion system increase the treatment burden on tertiary healthcare system after the initiation of LCIG-infusion. Most patients continue long-term with the infusion. Few patients discontinue infusion during the first year after initiation and living alone appears to be a risk factor for this outcome.
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Affiliation(s)
- Vili Viljaharju
- Department of Neurology Helsinki University Hospital Helsinki Finland.,Department of Clinical Neurosciences (Neurology) University of Helsinki Helsinki Finland
| | - Tuomas Mertsalmi
- Department of Neurology Helsinki University Hospital Helsinki Finland.,Department of Clinical Neurosciences (Neurology) University of Helsinki Helsinki Finland
| | - K Amande M Pauls
- Department of Neurology Helsinki University Hospital Helsinki Finland.,Department of Clinical Neurosciences (Neurology) University of Helsinki Helsinki Finland
| | - Maija Koivu
- Department of Neurology Helsinki University Hospital Helsinki Finland.,Department of Clinical Neurosciences (Neurology) University of Helsinki Helsinki Finland
| | - Johanna Eerola-Rautio
- Department of Neurology Helsinki University Hospital Helsinki Finland.,Department of Clinical Neurosciences (Neurology) University of Helsinki Helsinki Finland
| | - Marianne Udd
- Department of Gastroenterological Surgery Helsinki University Hospital Helsinki Finland
| | - Eero Pekkonen
- Department of Neurology Helsinki University Hospital Helsinki Finland.,Department of Clinical Neurosciences (Neurology) University of Helsinki Helsinki Finland
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Tsunemi T, Oyama G, Saiki S, Hatano T, Fukae J, Shimo Y, Hattori N. Intrajejunal Infusion of Levodopa/Carbidopa for Advanced Parkinson's Disease: A Systematic Review. Mov Disord 2021; 36:1759-1771. [PMID: 33899262 PMCID: PMC9290931 DOI: 10.1002/mds.28595] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 02/18/2021] [Accepted: 03/05/2021] [Indexed: 02/01/2023] Open
Abstract
Advanced Parkinson's disease is inconsistently defined, and evidence is lacking in relation to device‐aided therapies. To update existing reviews of intrajejunal infusion of levodopa/carbidopa (LCIG), we performed a literature search for relevant articles (to November 3, 2020) using PubMed supplemented by hand searching. Retrieved articles were categorized by relevance to identified research questions, including motor complications and symptoms; nonmotor symptoms; functioning, quality of life, and caregiver burden; optimal timing of treatment initiation and administration duration; discontinuation; and complications. Most eligible studies (n = 56) were open‐label, observational studies including relatively small patient numbers. LCIG consistently reduces OFF time and increased ON time without troublesome dyskinesia with varying effects regarding ON time with troublesome dyskinesia and the possibility of diphasic dyskinesia. More recent evidence provides some increased support for the benefits of LCIG in relation to nonmotor symptoms, quality of life, activities of daily living, and reduced caregiver burden. Patient age does not appear to significantly impact the effectiveness of LCIG. Discontinuation rates with LCIG (~17%–26%) commonly relate to device‐related issues, although the ability to easily discontinue LCIG may represent a potential benefit. LCIG may be a favorable option for patients with advanced Parkinson's disease who show predominant nonmotor symptoms and vulnerability to complications of other advanced therapy modalities. Larger, well‐controlled studies, including precise investigation of cost effectiveness, would further assist treatment selection. © 2021 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society
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Affiliation(s)
- Taiji Tsunemi
- Department of Neurology, Juntendo University School of Medicine, Tokyo, Japan
| | - Genko Oyama
- Department of Neurology, Juntendo University School of Medicine, Tokyo, Japan.,Neurodegenerative and Demented Disorders, Juntendo University School of Medicine, Tokyo, Japan.,Home Medical Care System Based on Information and Communications Technology, Juntendo University School of Medicine, Tokyo, Japan
| | - Shinji Saiki
- Department of Neurology, Juntendo University School of Medicine, Tokyo, Japan
| | - Taku Hatano
- Department of Neurology, Juntendo University School of Medicine, Tokyo, Japan.,Neurodegenerative and Demented Disorders, Juntendo University School of Medicine, Tokyo, Japan
| | - Jiro Fukae
- Department of Neurology, Juntendo Nerima Hospital, Tokyo, Japan
| | - Yasushi Shimo
- Department of Neurology, Juntendo Nerima Hospital, Tokyo, Japan.,Research and Therapeutics for Movement Disorders, Juntendo University School of Medicine, Tokyo, Japan
| | - Nobutaka Hattori
- Department of Neurology, Juntendo University School of Medicine, Tokyo, Japan.,Neurodegenerative and Demented Disorders, Juntendo University School of Medicine, Tokyo, Japan.,Home Medical Care System Based on Information and Communications Technology, Juntendo University School of Medicine, Tokyo, Japan.,Research and Therapeutics for Movement Disorders, Juntendo University School of Medicine, Tokyo, Japan
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11
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Constantin VA, Szász JA, Orbán-Kis K, Rosca EC, Popovici M, Cornea A, Bancu LA, Ciorba M, Mihály I, Nagy E, Szatmári S, Simu M. Levodopa-Carbidopa Intestinal Gel Infusion Therapy Discontinuation: A Ten-Year Retrospective Analysis of 204 Treated Patients. Neuropsychiatr Dis Treat 2020; 16:1835-1844. [PMID: 32801718 PMCID: PMC7395851 DOI: 10.2147/ndt.s256988] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 06/25/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Parkinson's disease (PD) is the second most common progressive neurodegenerative disease. In the advanced stages, the continuous delivery of levodopa (LD) as levodopa-carbidopa intestinal gel (LCIG) has demonstrated significant improvement of motor and nonmotor complications and improvement of the patients' quality of life (QoL). Despite the growing global experience with this treatment, anumber of unsolved practical issues remain, and currently, the data on the reasons that can lead to the discontinuation of LCIG are scarce. OBJECTIVE In the present study, we aimed to analyze the causes that led to the discontinuation of LCIG therapy. METHODS In this retrospective study, after 10 years of experience with LCIG as a therapeutic option in advanced PD, we analyzed the data of all dropout cases among the 204 patients that initiated LCIG therapy in two Romanian centers. RESULTS Of the 204 patients enrolled, 43 patients dropped out. Disease duration until LCIG infusion was significantly longer (11.67±4.98 vs 9.44±3.44) and the overall clinical picture more sever (both regarding motor symptoms and cognitive decline) in dropout patients (compared to patients who continued treatment). The dropout patients also presented significant differences regarding the incidence of polyneuropathy (32.5% vs 11.18%). The main cause of discontinuation was death. CONCLUSION The causes of discontinuation from LCIG therapy in Romanian patients are similar to those from other centers; however, the rate of dropouts is somewhat lower. The clinician's experience in selecting and treating the patients in advanced stages of PD can increase therapeutic adherence. Also, the presence of a well-trained caregiver along with the availability of a proper aftercare system is mandatory for maintaining the long-term benefits of the therapy and the overall best outcome possible. Targeted prospective studies are needed to confirm whether a more severe stage of the disease and cognitive impairment at the time of initiation, respectively, the association of polyneuropathy can be considered as predictive factors for dropout.
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Affiliation(s)
- Viorelia Adelina Constantin
- 2nd Clinic of Neurology, Târgu Mureș County Emergency Clinical Hospital, Târgu Mureș, Romania
- Doctoral School, “Victor Babes” University of Medicine and Pharmacy Timisoara, Timisoara, Romania
| | - József Attila Szász
- 2nd Clinic of Neurology, Târgu Mureș County Emergency Clinical Hospital, Târgu Mureș, Romania
- Department of Neurology, “George Emil Palade” University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, Târgu Mureș, Romania
| | - Károly Orbán-Kis
- 2nd Clinic of Neurology, Târgu Mureș County Emergency Clinical Hospital, Târgu Mureș, Romania
- Department of Physiology, “George Emil Palade” University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, Târgu Mureș, Romania
| | - Elena Cecilia Rosca
- Department of Neurology, “Victor Babes” University of Medicine and Pharmacy Timisoara, Timisoara, Romania
- Department of Neurology, “Pius Branzeu” Emergency Clinical County Hospital, Timisoara, Romania
| | | | - Amalia Cornea
- Department of Neurology, “Victor Babes” University of Medicine and Pharmacy Timisoara, Timisoara, Romania
- Department of Neurology, “Pius Branzeu” Emergency Clinical County Hospital, Timisoara, Romania
| | - Ligia Ariana Bancu
- Department of Internal Medicine, “George Emil Palade” University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, Târgu Mureș, Romania
- 1 Clinic of Internal Medicine, Târgu Mureș County Emergency Clinical Hospital, Târgu Mureș, Romania
| | - Marius Ciorba
- Department of Internal Medicine, “George Emil Palade” University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, Târgu Mureș, Romania
- Department of Gastroenterology, Târgu Mureș County Emergency Clinical Hospital, Târgu Mureș, Romania
| | - István Mihály
- 2nd Clinic of Neurology, Târgu Mureș County Emergency Clinical Hospital, Târgu Mureș, Romania
- Department of Physiology, “George Emil Palade” University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, Târgu Mureș, Romania
| | - Előd Nagy
- Department of Biochemistry and Environmental Chemistry, “George Emil Palade” University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, Târgu Mureș, Romania
- Laboratory of Medical Analysis, Clinical County Hospital Mureș, Târgu Mureș, Romania
| | - Szabolcs Szatmári
- 2nd Clinic of Neurology, Târgu Mureș County Emergency Clinical Hospital, Târgu Mureș, Romania
- Department of Neurology, “George Emil Palade” University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, Târgu Mureș, Romania
| | - Mihaela Simu
- Department of Neurology, “Victor Babes” University of Medicine and Pharmacy Timisoara, Timisoara, Romania
- Department of Neurology, “Pius Branzeu” Emergency Clinical County Hospital, Timisoara, Romania
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