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[Continuous dopaminergic stimulation by Duodopa in advanced Parkinson's disease: Efficacy and safety].
Rev Neurol (Paris). 2009 Aug-Sep; 165(8-9):718-27.RN

Abstract

INTRODUCTION

When advanced Parkinson's disease (PD) patients experience motor complications (fluctuations and dyskinesias) despite standard oral treatment, two treatment options are available: deep brain stimulation and subcutaneous apomorphine infusion with respects of indications for each strategy. Continuous intraduodenal infusion of levodopa (Duodopa) via a gastrojejunal tube may be proposed at this stage of the disease and the study of indications and clinical results with Duodopa may develop this new therapeutic alternative.

PATIENTS AND METHODS

Seven patients with advanced PD (dementia for all and psychiatric disorders for some of them, axial signs) were treated with Duodopa. We evaluated neuropsychological functions, all UPDRS scales, gait and quality-of-life just before Duodopa onset and six months after treatment end. Moreover, we described all adverse events (early and late) and studied daily levodopa doses before and 6 months after treatment.

RESULTS

We demonstrated an improvement in motor UPDRS (44%), in axial signs (40% for UPDRS part III axial subscore and 12% for gait) and a reduction of fluctuations (37.5%) and in UPDRS part IV dyskinesia (20%). These significant results are observed without any change in the quality-of-life. Adverse events were due to PEG positioning for four patients, the equipment (pump, connection, inner tube) for all patients and levodopa for four patients. Daily levodopa dose had to be increased 13.5%.

CONCLUSION

Duodopa can be considered as a new treatment strategy providing significant improvements in motor fluctuations, dyskinesia and severe axial signs. These results were demonstrated in very advanced PD patients, who had been excluded from previous studies, with cognitive disorders and for some of them dopaminergic psychosis well controlled by medications.

Authors+Show Affiliations

EA, IFR, hôpital Roger-Salengro, centre hospitalier et universitaire de Lille, France.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
English Abstract
Journal Article

Language

fre

PubMed ID

19150100

Citation

Annic, A, et al. "[Continuous Dopaminergic Stimulation By Duodopa in Advanced Parkinson's Disease: Efficacy and Safety]." Revue Neurologique, vol. 165, no. 8-9, 2009, pp. 718-27.
Annic A, Devos D, Seguy D, et al. [Continuous dopaminergic stimulation by Duodopa in advanced Parkinson's disease: Efficacy and safety]. Rev Neurol (Paris). 2009;165(8-9):718-27.
Annic, A., Devos, D., Seguy, D., Dujardin, K., Destée, A., & Defebvre, L. (2009). [Continuous dopaminergic stimulation by Duodopa in advanced Parkinson's disease: Efficacy and safety]. Revue Neurologique, 165(8-9), 718-27. https://doi.org/10.1016/j.neurol.2008.11.017
Annic A, et al. [Continuous Dopaminergic Stimulation By Duodopa in Advanced Parkinson's Disease: Efficacy and Safety]. Rev Neurol (Paris). 2009 Aug-Sep;165(8-9):718-27. PubMed PMID: 19150100.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - [Continuous dopaminergic stimulation by Duodopa in advanced Parkinson's disease: Efficacy and safety]. AU - Annic,A, AU - Devos,D, AU - Seguy,D, AU - Dujardin,K, AU - Destée,A, AU - Defebvre,L, Y1 - 2009/01/15/ PY - 2008/06/19/received PY - 2008/09/03/revised PY - 2008/11/17/accepted PY - 2009/1/20/entrez PY - 2009/1/20/pubmed PY - 2009/11/17/medline SP - 718 EP - 27 JF - Revue neurologique JO - Rev Neurol (Paris) VL - 165 IS - 8-9 N2 - INTRODUCTION: When advanced Parkinson's disease (PD) patients experience motor complications (fluctuations and dyskinesias) despite standard oral treatment, two treatment options are available: deep brain stimulation and subcutaneous apomorphine infusion with respects of indications for each strategy. Continuous intraduodenal infusion of levodopa (Duodopa) via a gastrojejunal tube may be proposed at this stage of the disease and the study of indications and clinical results with Duodopa may develop this new therapeutic alternative. PATIENTS AND METHODS: Seven patients with advanced PD (dementia for all and psychiatric disorders for some of them, axial signs) were treated with Duodopa. We evaluated neuropsychological functions, all UPDRS scales, gait and quality-of-life just before Duodopa onset and six months after treatment end. Moreover, we described all adverse events (early and late) and studied daily levodopa doses before and 6 months after treatment. RESULTS: We demonstrated an improvement in motor UPDRS (44%), in axial signs (40% for UPDRS part III axial subscore and 12% for gait) and a reduction of fluctuations (37.5%) and in UPDRS part IV dyskinesia (20%). These significant results are observed without any change in the quality-of-life. Adverse events were due to PEG positioning for four patients, the equipment (pump, connection, inner tube) for all patients and levodopa for four patients. Daily levodopa dose had to be increased 13.5%. CONCLUSION: Duodopa can be considered as a new treatment strategy providing significant improvements in motor fluctuations, dyskinesia and severe axial signs. These results were demonstrated in very advanced PD patients, who had been excluded from previous studies, with cognitive disorders and for some of them dopaminergic psychosis well controlled by medications. SN - 0035-3787 UR - https://www.unboundmedicine.com/medline/citation/19150100/[Continuous_dopaminergic_stimulation_by_Duodopa_in_advanced_Parkinson's_disease:_Efficacy_and_safety]_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0035-3787(08)00684-X DB - PRIME DP - Unbound Medicine ER -