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Marano M, Fasano A. Subthalamic Nucleus Deep Brain Stimulation as Rescue Therapy for Levodopa Carbidopa Intestinal Gel-Associated Biphasic-Like Dyskinesias. Mov Disord Clin Pract 2021; 8:1155-1156. [PMID: 34631959 DOI: 10.1002/mdc3.13277] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 05/10/2021] [Indexed: 11/07/2022] Open
Affiliation(s)
- Massimo Marano
- Neurology, Neurophysiology and Neurobiology Unit, Department of Medicine University Campus Bio-Medico of Rome Rome Italy
| | - Alfonso Fasano
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Toronto, Ontario, Canada. Division of Neurology University of Toronto Toronto Ontario Canada
- Krembil Brain Institute Toronto Ontario Canada
- Center for Advancing Neurotechnological Innovation to Application Toronto Ontario Canada
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Marano M, Naranian T, di Biase L, Di Santo A, Poon YY, Arca R, Cossu G, Marano P, Di Lazzaro V, Fasano A. Complex dyskinesias in Parkinson patients on levodopa/carbidopa intestinal gel. Parkinsonism Relat Disord 2019; 69:140-146. [PMID: 31759188 DOI: 10.1016/j.parkreldis.2019.11.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 11/09/2019] [Indexed: 01/01/2023]
Abstract
BACKGROUND Levodopa-carbidopa intestinal infusion is an effective treatment for motor fluctuations in Parkinson's disease. However, it has been recently associated with emergent complex/atypical dyskinesias. We sought to characterize patients who developed these dyskinesias after levodopa infusion initiation, and to compare these patients to a control population with conventional motor fluctuations. METHODS 208 Parkinson's disease patients, treated with levodopa intestinal infusion due to motor fluctuations, were screened for onset and/or worsening of dyskinesias after initiation of levodopa infusion, resistant to the routine titration, and presenting with atypical or unexpected patterns. Patients with extensive follow-up data were enrolled for a longitudinal analysis. Cases were compared to a control sample with conventional motor fluctuations in order to investigate predisposing factors, difference in dyskinesia phenotype, management strategies and dropouts. RESULTS Thirty patients out of 208 (14.4%) reported atypical (i.e. long-lasting) biphasic, biphasic-like (i.e. continuous) or mixed (peak-dose and continuous biphasic) dyskinesias after levodopa infusion. They were compared at baseline and follow-up to a sample of 49 patients with conventional motor fluctuations on levodopa infusion. Both groups had similar demographic and clinical features, except the former having higher prevalence of biphasic dyskinesias while on oral therapy. Biphasic-like dyskinesias in nearly half the number of cases improved with increasing the dopaminergic load, while mixed dyskinesias had the worst outcome and highest dropout rate (58%). CONCLUSIONS Atypical biphasic, biphasic-like and complex dyskinesias could hinder the course of patients treated with levodopa infusion. This study further informs the selection process of advanced therapies, particularly in dyskinetic patients.
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Affiliation(s)
- Massimo Marano
- Unit of Neurology, Neurophysiology and Neurobiology, Department of Medicine, Campus Bio-Medico of Rome University, Rome, Italy
| | - Taline Naranian
- Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Centre and the Toronto Western Hospital, UHN, Toronto, Ontario, Canada
| | - Lazzaro di Biase
- Unit of Neurology, Neurophysiology and Neurobiology, Department of Medicine, Campus Bio-Medico of Rome University, Rome, Italy
| | - Alessandro Di Santo
- Unit of Neurology, Neurophysiology and Neurobiology, Department of Medicine, Campus Bio-Medico of Rome University, Rome, Italy
| | - Yu-Yan Poon
- Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Centre and the Toronto Western Hospital, UHN, Toronto, Ontario, Canada
| | - Roberta Arca
- Department of Neurology, Bruneck Hospital, ASDAA, Bruneck, Italy
| | | | - Pietro Marano
- Department of Neuro-rehabilitation, Madonna del Rosario Clinic, Catania, Italy
| | - Vincenzo Di Lazzaro
- Unit of Neurology, Neurophysiology and Neurobiology, Department of Medicine, Campus Bio-Medico of Rome University, Rome, Italy
| | - Alfonso Fasano
- Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Centre and the Toronto Western Hospital, UHN, Toronto, Ontario, Canada; Division of Neurology, Department of Medicine, University of Toronto, Toronto, Canada; Krembil Brain Institute, Toronto, Ontario, Canada; CenteR for Advancing Neurotechnological Innovation to Application (CRANIA), Toronto, ON, Canada.
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Paramanandam V, Lizarraga KJ, Soh D, Algarni M, Rohani M, Fasano A. Unusual gait disorders: a phenomenological approach and classification. Expert Rev Neurother 2018; 19:119-132. [DOI: 10.1080/14737175.2019.1562337] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Vijayashankar Paramanandam
- Edmond J. Safra Program in Parkinson’s Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital and Division of Neurology, UHN, Division of Neurology, University of Toronto, Toronto, ON, Canada
| | - Karlo J. Lizarraga
- Edmond J. Safra Program in Parkinson’s Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital and Division of Neurology, UHN, Division of Neurology, University of Toronto, Toronto, ON, Canada
| | - Derrick Soh
- Edmond J. Safra Program in Parkinson’s Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital and Division of Neurology, UHN, Division of Neurology, University of Toronto, Toronto, ON, Canada
| | - Musleh Algarni
- Edmond J. Safra Program in Parkinson’s Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital and Division of Neurology, UHN, Division of Neurology, University of Toronto, Toronto, ON, Canada
| | - Mohammad Rohani
- Department of Neurology, Hazrat Rasool Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Alfonso Fasano
- Edmond J. Safra Program in Parkinson’s Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital and Division of Neurology, UHN, Division of Neurology, University of Toronto, Toronto, ON, Canada
- Krembil Brain Institute, Toronto, ON, Canada
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