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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Beccuti G, Guaraldi F, Natta G, Cambria V, Prencipe N, Cicolin A, Montanaro E, Lopiano L, Ghigo E, Zibetti M, Grottoli S. Increased prevalence of impulse control disorder symptoms in endocrine diseases treated with dopamine agonists: a cross-sectional study. J Endocrinol Invest 2021; 44:1699-1706. [PMID: 33314003 PMCID: PMC8285332 DOI: 10.1007/s40618-020-01478-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 11/24/2020] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Impulse control disorders (ICDs) have been described as a side effect of dopamine agonists (DAs) in neurological as well as endocrine conditions. Few studies have evaluated the neuropsychological effect of DAs in hyperprolactinemic patients, and these have reported a relationship between DAs and ICDs. Our objective was to screen for ICD symptoms in individuals with DA-treated endocrine conditions. MATERIALS AND METHODS A cross-sectional analysis was conducted on 132 patients with pituitary disorders treated with DAs (DA exposed), as well as 58 patients with pituitary disorders and no history of DA exposure (non-DA exposed). Participants responded to the full version of the Questionnaire for Impulsive-Compulsive Disorders in Parkinson's disease (QUIP). RESULTS Compared with the non-DA-exposed group, a higher prevalence of DA-exposed patients tested positive for symptoms of any ICD or related behavior (52% vs. 31%, p < 0.01), any ICD (46% vs. 24%, p < 0.01), any related behavior (31% vs. 17%, p < 0.05), compulsive sexual behavior (27% vs. 14%, p < 0.04), and punding (20% vs. 7%, p < 0.02) by QUIP. On univariate analysis, DA treatment was associated with a two- to threefold increased risk of any ICD or related behavior [odds ratio (OR) 2.43] and any ICD (OR 2.70). In a multivariate analysis, independent risk factors for any ICD or related behavior were DA use (adjusted OR 2.22) and age (adjusted OR 6.76). Male gender was predictive of the risk of hypersexuality (adjusted OR 3.82). DISCUSSION Despite the QUIP limitations, a clear sign of increased risk of ICDs emerges in individuals with DA-treated pituitary disorders. Our data contribute to the growing evidence of DA-induced ICDs in endocrine conditions.
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Affiliation(s)
- G Beccuti
- Division of Endocrinology, Diabetes and Metabolism, Department of Medical Sciences, University of Turin, Corso Dogliotti 14, 10126, Turin, Italy.
| | - F Guaraldi
- IRCCS Istituto Delle Scienze Neurologiche Di Bologna, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - G Natta
- Division of Endocrinology, Diabetes and Metabolism, Department of Medical Sciences, University of Turin, Corso Dogliotti 14, 10126, Turin, Italy
- Division of Pediatrics, Department of Public Health and Pediatrics, University of Turin, Turin, Italy
| | - V Cambria
- Division of Endocrinology, Diabetes and Metabolism, Department of Medical Sciences, University of Turin, Corso Dogliotti 14, 10126, Turin, Italy
| | - N Prencipe
- Division of Endocrinology, Diabetes and Metabolism, Department of Medical Sciences, University of Turin, Corso Dogliotti 14, 10126, Turin, Italy
| | - A Cicolin
- Sleep Medicine Center, Department of Neurosciences "Rita Levi Montalcini", University of Turin, Turin, Italy
| | - E Montanaro
- Division of Neurology, Department of Neurosciences "Rita Levi Montalcini", University of Turin, Turin, Italy
| | - L Lopiano
- Division of Neurology, Department of Neurosciences "Rita Levi Montalcini", University of Turin, Turin, Italy
| | - E Ghigo
- Division of Endocrinology, Diabetes and Metabolism, Department of Medical Sciences, University of Turin, Corso Dogliotti 14, 10126, Turin, Italy
| | - M Zibetti
- Division of Neurology, Department of Neurosciences "Rita Levi Montalcini", University of Turin, Turin, Italy
| | - S Grottoli
- Division of Endocrinology, Diabetes and Metabolism, Department of Medical Sciences, University of Turin, Corso Dogliotti 14, 10126, Turin, Italy
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Balestrino R, Rizzone M, Zibetti M, Romagnolo A, Artusi CA, Montanaro E, Lopiano L. Onset of Covid-19 with impaired consciousness and ataxia: a case report. J Neurol 2020; 267:2797-2798. [PMID: 32462348 PMCID: PMC7251556 DOI: 10.1007/s00415-020-09879-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 04/27/2020] [Accepted: 04/29/2020] [Indexed: 01/08/2023]
Affiliation(s)
- R Balestrino
- Dipartimento di Neuroscienze, Universita degli Studi di Torino, Turin, Italy
| | - M Rizzone
- Dipartimento di Neuroscienze, Universita degli Studi di Torino, Turin, Italy
| | - M Zibetti
- Dipartimento di Neuroscienze, Universita degli Studi di Torino, Turin, Italy
| | - A Romagnolo
- Dipartimento di Neuroscienze, Universita degli Studi di Torino, Turin, Italy
| | - C A Artusi
- Dipartimento di Neuroscienze, Universita degli Studi di Torino, Turin, Italy
| | - E Montanaro
- Dipartimento di Neuroscienze, Universita degli Studi di Torino, Turin, Italy
| | - L Lopiano
- Dipartimento di Neuroscienze, Universita degli Studi di Torino, Turin, Italy.
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Fabbri M, Zibetti M, Beccaria L, Merola A, Romagnolo A, Montanaro E, Ferreira JJ, Palermo S, Lopiano L. Levodopa/carbidopa intestinal gel infusion and weight loss in Parkinson's disease. Eur J Neurol 2018; 26:490-496. [PMID: 30347489 DOI: 10.1111/ene.13844] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 10/12/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND PURPOSE Weight loss (WL) is a frequent yet under-recognized complication of levodopa/carbidopa intestinal gel (LCIG) infusion, as well as a milestone of Parkinson's disease (PD) disability progression. The complex association between WL, poor nutritional status, motor complications and PD progression, however, remains unclear. METHODS Consecutive consenting patients with PD treated with LCIG (n = 44; PD duration, 18.3 ± 6.5 years) were enrolled in an open-label observational study assessing the extent of WL occurring during LCIG treatment. As secondary aims, we correlated the nutritional status, as detected by the Mini Nutritional Assessment, with the severity of motor symptoms [Movement Disorder Society Unified Parkinson's Disease Rating Scale part III], motor complications (Unified Parkinson's Disease Rating Scale part IV), activities of daily living (Schwab and England scale), cognitive impairment (Mini Mental State Examination), depression (Beck Depression Inventory), difficulties in feeding (Edinburgh Feeding Evaluation in Dementia Questionnaire) and levodopa equivalent daily dose (LEDD). RESULTS There was an average WL of 9.9 ± 10.5% (7.6 ± 7.1 kg) over an LCIG treatment period of 51.6 ± 28.5 months. The extent of WL correlated with the percentage of the waking day spent with dyskinesia (P < 0.05). The nutritional status correlated with motor symptom severity (P < 0.01), dysphagia (P < 0.01) and LEDD (P < 0.01). CONCLUSIONS Weight loss may occur in patients with PD undergoing LCIG in correlation with the percentage of the waking day spent with dyskinesia. Regardless of the extent of WL, the nutritional status correlated with higher LEDD, as well as with indices of disease progression, such as motor symptom severity and dysphagia.
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Affiliation(s)
- M Fabbri
- Instituto de Medicina Molecular, Faculty of Medicine, University of Lisbon, Lisbon, Portugal.,Department of Neuroscience 'Rita Levi Montalcini', University of Torino, Turin, Italy
| | - M Zibetti
- Department of Neuroscience 'Rita Levi Montalcini', University of Torino, Turin, Italy
| | - L Beccaria
- Department of Neuroscience 'Rita Levi Montalcini', University of Torino, Turin, Italy
| | - A Merola
- Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH, USA
| | - A Romagnolo
- Department of Neuroscience 'Rita Levi Montalcini', University of Torino, Turin, Italy
| | - E Montanaro
- Department of Neuroscience 'Rita Levi Montalcini', University of Torino, Turin, Italy
| | - J J Ferreira
- Instituto de Medicina Molecular, Faculty of Medicine, University of Lisbon, Lisbon, Portugal.,Laboratory of Clinical Pharmacology and Therapeutics, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - S Palermo
- Department of Psychology, University of Turin, Turin, Italy
| | - L Lopiano
- Department of Neuroscience 'Rita Levi Montalcini', University of Torino, Turin, Italy
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Petit G, Kornreich C, Noel X, Verbanck P, Campanella S, Choi J, Park SM, Park CB, Gwak AR, Hwang JY, Lee JY, Jung HY, Maurage P, Noel X, Joassin F, Philippot P, Hanak C, Verbank P, Luminet O, de Timary P, Campanella S, Grynberg D, Maurage P, Noel X, Joassin F, Hanak C, Verbank P, Luminet O, de Timary P, Campanella S, Philippot P, Grynberg D, Nyssen L, Quertemont E, Noel X, Doallo S, Gomez-Suarez A, Malkowska A, Topolewska-Wochowska A, Bamburowicz-Klimkowska M, Matsumoto H, Szutowski M, Wojnar M, Corral M, Mateos P, Porras C, Garcia-Moreno LM, Cadaveira F, Rubio G, Libman-Sokolowska M, Matsumoto H, Sygitowicz G, Filipek A, Piwowarska J, Dziklinska A, Radziwon-Zaleska M, Ryszewska-Pokrasniewicz B, Skalski M, Naruszewicz M, Biecek P, Tyce M, Zwierzchowska K, Nasierowski T, Sitkiewicz D, Wojnar M, Kalk N, Cherian R, Naveed M, Newson M, Cavanagh J, Rabiner E, Dar K, McInnes I, Lingford-Hughes A, Neumann A, Vande Weghe N, Philippot P, Luminet O, de Timary P, Vilenne A, Kreusch F, Quertemont E, Brkic S, Soderpalm B, Soderpalm-Gordh A, Oswald L, Wand G, Kuwabara H, Wong D, Brown C, Hutchison KE, Karoly H, Bryan AD, Thayer R, Weiland B, Harlaar N, Bryan AD, Thayer R, Weiland B, Montanaro E, Hutchison K, Lason W, Walecki P, Gorzelanczyk EJ, Walecki P, Gorzelanczyk EJ, Feit J, Pasgreta K, Lason W, Ziolkowski M. PSYCHOLOGY AND MARKERS. Alcohol Alcohol 2013. [DOI: 10.1093/alcalc/agt117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Zibetti M, Rizzone M, Merola A, Angrisano S, Rizzi L, Montanaro E, Cicolin A, Lopiano L. Sleep improvement with levodopa/carbidopa intestinal gel infusion in Parkinson disease. Acta Neurol Scand 2013; 127:e28-32. [PMID: 23311399 DOI: 10.1111/ane.12075] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/26/2012] [Indexed: 11/30/2022]
Abstract
BACKGROUND Sleep disorders are common in patients with advanced Parkinson's disease (PD). Nocturnal akinesia and sleep fragmentation frequently coexist with daytime sleepiness, influencing daytime functioning. Levodopa/carbidopa intestinal gel (LCIG) infusion has been shown to improve motor complications in advanced PD, and preliminary findings suggest that sleep might improve following LCIG infusion. OBJECTIVE To analyze the impact of LCIG infusion on sleep symptoms and daytime sleepiness in patients with PD. METHODS Twelve consecutive patients with PD completed the PD-Sleep-Scale-version-2 (PDSS-2) and the Epworth-Sleepiness-Scale (ESS) at baseline and after 2-4 months of LCIG treatment. Activities of daily living, motor symptoms and complications were assessed with the Unified-PD-rating-Scale section II, III, and IV. RESULTS Nocturnal sleep improved substantially in all patients switched to LCIG infusion. PDSS-2 total score and subscores for 'Disturbed sleep', 'Motor symptoms at night', and 'PD symptoms at night' were significantly reduced. ESS measures of daytime sleepiness also improved. Motor complications and activities of daily living improved significantly with LCIG. CONCLUSION Subjective measures of sleep quality and daytime sleepiness improve in patients with advanced PD undergoing LCIG infusion. Further studies with a larger number of patients and polysomnographic recordings are needed to confirm the beneficial effect on sleep and clarify the underlying mechanisms.
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Affiliation(s)
- M. Zibetti
- Department of Neuroscience; University of Torino; Torino; Italy
| | - M. Rizzone
- Department of Neuroscience; University of Torino; Torino; Italy
| | - A. Merola
- Department of Neuroscience; University of Torino; Torino; Italy
| | - S. Angrisano
- Department of Neuroscience; University of Torino; Torino; Italy
| | - L. Rizzi
- Department of Neuroscience; University of Torino; Torino; Italy
| | - E. Montanaro
- Department of Neuroscience; University of Torino; Torino; Italy
| | - A. Cicolin
- Department of Neuroscience; University of Torino; Torino; Italy
| | - L. Lopiano
- Department of Neuroscience; University of Torino; Torino; Italy
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Michelotti A, Venturini M, Tibaldi C, Bengala C, Gallo L, Carnino F, Del Mastro L, Lionetto R, Montanaro E, Rosso R, Conte P. Single agent epirubicin as first line chemotherapy for metastatic breast cancer patients. Breast Cancer Res Treat 2000; 59:133-9. [PMID: 10817348 DOI: 10.1023/a:1006394801389] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
In order to better explore the toxicity and the activity of high dose epirubicin (120 mg/m2, 3 weeks) we analyzed a population of 127 metastatic breast cancer patients, treated in a randomized clinical trial conducted to evaluate the cardioprotective effect of dexrazoxane against epirubicin induced cardiotoxicity. All the patients had a diagnosis of metastatic breast cancer, an ECOG performance status < or = 2 and normal hematologic, renal, hepatic and cardiac function. No prior adjuvant chemotherapy including anthracycline was allowed. Epirubicin was given at the dose of 120 mg/m2 i.v. bolus every 3 weeks. One hundred twenty five patients were evaluable for toxicity and response. Seventeen patients (11%) had a complete response and 47 patients (37%) a partial response, for an overall response rate of 48%. The median progression free and overall survivals were 8.3 months and 18.3 months, respectively. Grade 3 and 4 leukopenia were observed in 8% and 7% of the patients, respectively. The most frequent nonhematological grade 3 toxicities were alopecia (87%), nausea and vomiting (16%), and mucositis (8%). Cardiotoxicity, defined as occurrence of congestive heart failure, decrease in resting left ventricular ejection fraction (L-VEF) to < or = 45%, or 20 EF units decrease from baseline L-VEF, was observed in 19% of the patients, after a median cumulative dose of epirubicin of 720 mg/m2 (range 120-1440). This study confirms in a large series of patients the activity of high dose epirubicin; however, the high incidence of cardiotoxicity requires a careful evaluation of cardiac risk factors before treatment.
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Affiliation(s)
- A Michelotti
- U. O. Oncologia Medica, Dipartimento di Oncologia Ospedale S. Chiara, Pisa, Italy
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