Experience with continuous levodopa enteral infusion (Duodopa®)in patients with advanced Parkinson's disease in a secondary level hospital

Santos-García, D.; Macías, M.; Llaneza, M.; Fuster-Sanjurjo, L.; Echarri-Piudo, A.; Belmonte, S.; Blanco, S.

doi:10.1016/S2173-5808(20)70101-X

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Abstract

Introduction

Continuous levodopa delivery by enteral infusion (Duodopa®) is an alternative to deep brain stimulation and subcutaneous apomorphine to control motor fluctuations and dyskinesias in advanced Parkinson's disease (PD). We report our experience with Duodopa® therapy in 11 patients with advanced PD.

Methods

We retrospectively assessed clinical and quality of life changes in all patients with PD with severe motor fluctuations and dyskinesias who started continuous daily levodopa duodenal infusion through percutaneous endoscopic gastrostomy from September 2006 (Duodopa® was approved for advanced PD treatment in Spain at that date) until April 2010 at the A. Marcide Hospital of Spain.

Results

Nine patients received Duodopa® [62.7±10.6 (44–74) years, 63.6% male)]. Pre- Duodopa® clinical characteristics of patients were: disease duration 14.5±8.9 (3–34) years, oral levodopa dose 918.2±277.7 (450–1300) mg/day, and Hoehn and Yahr staging 3.7±0.5 (3–4). Nine patients are still receiving Duodopa®. Patients improved motor fluctuations (72.7% significant improvement), dyskinesia (55.5% significant improvement), daily off-time (90.9%) and daily duration dyskinesia (66.6%) after total infusion time of 170.5 months (3–31). The improvement in Parkinson's Disease Quality of Life Questionnaire-39 (PDQ-39) and Schwab&England Capacity for Daily Living Scale were 38.5±19.8 and 24±12.5 respectively (P<0.05). Equivalent daily dose of levodopa (April 2010) was 1683.4±295.8 (1234–2216) mg/day.

Conclusions

Intraduodenal infusion of levodopa offers an important alternative in treating patients with advanced Parkinson disease

Keywords:

Dyskinesias

Duodopa

Parkinson's disease

Motor fluctuations

Continuous enteral infusion

Levodopa

Resumen

Introducción

La infusión continua de levodopa intraduodenal (Duodopa®) constituye una alternativa a la infusión subcutánea de apomorfina y a la cirugía en pacientes con enfermedad de Parkinson (EP) avanzada. Describimos nuestra experiencia con Duodopa® en pacientes con EP avanzada.

Métodos

Realizamos un estudio epidemiológico, observacional, no intervencionista, poblacional, descriptivo, y retrospectivo, en el que se incluyen todos aquellos pacientes con EP avanzada tratados con Duodopa® por parte de la Sección de Neurología del Hospital A. Marcide de Ferrol hasta abril de 2010.

Resultados

Once de un total de 12 pacientes seleccionados fueron tratados con Duodopa® [63,6% varones; edad media 62,7±10,6 (44–74) años]. En el momento de ser seleccionados para recibir Duodopa® presentaban: tiempo medio de evolución de enfermedad de 14,5±8,9 (3–34) años, dosis media de levodopa oral de 918,2±277,7 (450–1300) mg/ día, y un estadio de Hoehn y Yahr de 3,7±0,5 (3–4). Nueve pacientes mantienen el tratamiento con Duodopa®. Hubo mejoría en las fluctuaciones motoras (72,7% gran mejoría) y discinesias (55,5% gran mejoría) con reducción del tiempo off/día (90,9%) y tiempo con discinesias/día (66,6%) después de un tiempo total de seguimiento con Duodopa® de 170,5 (3–31) meses. La mejoría en las escalas PDQ-39 y Schwab&England fue de 38,5±19,8 y 24±12,5 puntos respectivamente (p<0,05). La dosis media equivalente oral de levodopa (abril 2010) fue de 1683,4±295,8 (1234–2216) mg/día.

Conclusiones

Duodopa® pudiera ser un tratamiento efectivo, seguro, y bien tolerado alternativo a la cirugía y apomorfina subcutánea en pacientes con EP avanzada adecuadamente seleccionados.

Palabras clave:

Discinesias

Duodopa

Enfermedad de Parkinson

Fluctuaciones motoras

Infusión continua enteral

Levodopa

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☆

This work has been (partially) presented as an oral communication at the last meeting of the Spanish Neurology Society, which took place in Barcelona on November 17–21, 2009.

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