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Complex dyskinesias in Parkinson patients on levodopa/carbidopa intestinal gel.
Parkinsonism Relat Disord. 2019 12; 69:140-146.PR

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.

Authors+Show Affiliations

Unit of Neurology, Neurophysiology and Neurobiology, Department of Medicine, Campus Bio-Medico of Rome University, Rome, Italy.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.Unit of Neurology, Neurophysiology and Neurobiology, Department of Medicine, Campus Bio-Medico of Rome University, Rome, Italy.Unit of Neurology, Neurophysiology and Neurobiology, Department of Medicine, Campus Bio-Medico of Rome University, Rome, Italy.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.Department of Neurology, Bruneck Hospital, ASDAA, Bruneck, Italy.Neurology Department, AO "Brotzu", Cagliari, Italy.Department of Neuro-rehabilitation, Madonna del Rosario Clinic, Catania, Italy.Unit of Neurology, Neurophysiology and Neurobiology, Department of Medicine, Campus Bio-Medico of Rome University, Rome, Italy.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. Electronic address: alfonso.fasano@uhn.ca.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31759188

Citation

Marano, Massimo, et al. "Complex Dyskinesias in Parkinson Patients On Levodopa/carbidopa Intestinal Gel." Parkinsonism & Related Disorders, vol. 69, 2019, pp. 140-146.
Marano M, Naranian T, di Biase L, et al. Complex dyskinesias in Parkinson patients on levodopa/carbidopa intestinal gel. Parkinsonism Relat Disord. 2019;69:140-146.
Marano, M., Naranian, T., di Biase, L., Di Santo, A., Poon, Y. Y., Arca, R., Cossu, G., Marano, P., Di Lazzaro, V., & Fasano, A. (2019). Complex dyskinesias in Parkinson patients on levodopa/carbidopa intestinal gel. Parkinsonism & Related Disorders, 69, 140-146. https://doi.org/10.1016/j.parkreldis.2019.11.008
Marano M, et al. Complex Dyskinesias in Parkinson Patients On Levodopa/carbidopa Intestinal Gel. Parkinsonism Relat Disord. 2019;69:140-146. PubMed PMID: 31759188.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Complex dyskinesias in Parkinson patients on levodopa/carbidopa intestinal gel. AU - Marano,Massimo, AU - Naranian,Taline, AU - di Biase,Lazzaro, AU - Di Santo,Alessandro, AU - Poon,Yu-Yan, AU - Arca,Roberta, AU - Cossu,Giovanni, AU - Marano,Pietro, AU - Di Lazzaro,Vincenzo, AU - Fasano,Alfonso, Y1 - 2019/11/14/ PY - 2019/07/26/received PY - 2019/11/09/accepted PY - 2019/11/24/pubmed PY - 2020/9/2/medline PY - 2019/11/24/entrez KW - Biphasic dyskinesias KW - Device-aided therapies KW - Levodopa infusion KW - Motor fluctuations KW - Parkinson's disease SP - 140 EP - 146 JF - Parkinsonism & related disorders JO - Parkinsonism Relat Disord VL - 69 N2 - 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. SN - 1873-5126 UR - https://www.unboundmedicine.com/medline/citation/31759188/Complex_dyskinesias_in_Parkinson_patients_on_levodopa/carbidopa_intestinal_gel_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1353-8020(19)30484-5 DB - PRIME DP - Unbound Medicine ER -