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Ziegeler B, D' Souza W, Vinton A, Mulukutla S, Shaw C, Carne R. Neurological Health: Not Merely the Absence of Disease: Current Wellbeing Instruments Across the Spectrum of Neurology. Am J Lifestyle Med 2023; 17:299-316. [PMID: 36896041 PMCID: PMC9989493 DOI: 10.1177/15598276221086584] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Well-being and quality of life can vary independently of disease. Instruments measuring well-being and quality of life are commonly used in neurology, but there has been little investigation into the extent in which they accurately measure wellbeing/quality of life or if they merely reflect a diseased state of an individual. DESIGN Systematic searches, thematic analysis and narrative synthesis were undertaken. Individual items from instruments represented in ≥ 5 publications were categorised independently, without prior training, by five neurologists and one well-being researcher, as relating to 'disease-effect' or 'Well-being' with a study-created instrument. Items were additionally categorised into well-being domains. DATA SOURCES MEDLINE, EMBASE, EMCARE and PsycINFO from 1990 to 2020 were performed, across the 13 most prevalent neurological diseases. RESULTS 301 unique instruments were identified. Multiple sclerosis had most unique instruments at 92. SF-36 was used most, in 66 studies. 22 instruments appeared in ≥ 5 publications: 19/22 'well-being' outcome instruments predominantly measured disease effect (Fleiss kappa = .60). Only 1/22 instruments was categorised unanimously as relating to well-being. Instruments predominantly measured mental, physical and activity domains, over social or spiritual. CONCLUSIONS Most neurological well-being or quality-of-life instruments predominantly measure disease effect, rather than disease-independent well-being. Instruments differed widely in well-being domains examined.
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Affiliation(s)
| | | | | | | | - Cameron Shaw
- University Hospital Geelong, Deakin University, Geelong, VIC, Australia
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2
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Norlin JM, Willis M, Persson U, Andersson E, Pålhagen S, Odin P. Swedish guidelines for device-aided therapies in Parkinson's disease -Economic evaluation and implementation. Acta Neurol Scand 2021; 144:170-178. [PMID: 33899213 DOI: 10.1111/ane.13434] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 04/07/2021] [Accepted: 04/08/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The National Board of Health and Welfare in Sweden published the national guidelines for Parkinson's Disease 2016. The aim of this study was to summarize this evidence review and development of the guidelines, focusing on the economic evaluation of device-aided therapies (deep brain stimulation, pump-based infusion of levodopa-carbidopa intestinal gel or apomorphine) for Parkinson's disease, and the rate of implementation after 3 years in Sweden. MATERIAL AND METHODS The evidence review underlying the guidelines-including systematic literature searches of clinical and economic evidence, model-based economic evaluation, and formal analysis and guideline development-was examined, condensed, and translated. The impact of the guidelines was assessed with treatment use statistics from 2009 to 2019. RESULTS All device-aided therapies were assigned high priority. Based on a relatively low proportion of device-aided therapies (30%) in Parkinson's disease, a 5-year increase of 500 patients was recommended. This was estimated to reduce total costs by SEK 14 million (€1.7 million). Follow-up data found an increase of 217 patients between 2017 and 2019, following the same trend as before the guidelines. CONCLUSION Three years after the guidelines were published, the use of device-aided therapies has increased in Sweden, albeit not in pace with recommendations. One reason for slow implementation may be poor incentivization related to budget silos in which the costs for device-aided therapies are borne by the regions but the cost offsets (eg, reduced need for home care) are reaped by local stakeholders.
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Affiliation(s)
| | | | - Ulf Persson
- The Swedish Institute for Health Economics Lund Sweden
| | | | - Sven Pålhagen
- Division of Neurology Department of Clinical Neuroscience Karolinska Institutet Stockholm Sweden
- Department of Neurology, Rehabilitation Medicine, Memory Disorders, and Geriatrics Skåne University Hospital Malmö Sweden
| | - Per Odin
- Department of Neurology, Rehabilitation Medicine, Memory Disorders, and Geriatrics Skåne University Hospital Malmö Sweden
- Restorative Parkinson Unit Division of Neurology Department of Clinical Sciences Lund Lund University Lund Sweden
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Nijhuis FAP, Esselink R, de Bie RMA, Groenewoud H, Bloem BR, Post B, Meinders MJ. Translating Evidence to Advanced Parkinson's Disease Patients: A Systematic Review and Meta-Analysis. Mov Disord 2021; 36:1293-1307. [PMID: 33797786 PMCID: PMC8252410 DOI: 10.1002/mds.28599] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 02/02/2021] [Accepted: 03/01/2021] [Indexed: 12/19/2022] Open
Abstract
In the advanced stages of Parkinson's disease (PD), patients frequently experience disabling motor complications. Treatment options include deep brain stimulation (DBS), levodopa‐carbidopa intestinal gel (LCIG), and continuous subcutaneous apomorphine infusion (CSAI). Choosing among these treatments is influenced by scientific evidence, clinical expertise, and patient preferences. To foster patient engagement in decision‐making among the options, scientific evidence should be adjusted to their information needs. We conducted a systematic review from the patient perspective. First, patients selected outcomes for a treatment choice: quality of life, activities of daily living, ON and OFF time, and adverse events. Second, we conducted a systematic review and meta‐analysis for each treatment versus best medical treatment using Grading of Recommendations, Assessment, Development, and Evaluation (GRADE). Finally, the evidence was transformed into comprehensible and comparable information. We converted the meta‐analysis results into the number of patients (per 100) who benefit clinically from an advanced treatment per outcome, based on the minimal clinically important difference and the cumulative distribution function. Although this approach allows for a comparison of outcomes across the three device‐aided therapies, they have never been compared directly. The interpretation is hindered by the relatively short follow‐up time in the included studies, usually less than 12 months. These limitations should be clarified to patients during the decision‐making process. This review can help patients integrate the evidence with their own preferences, and with their clinician's expertise, to reach an informed decision. © 2021 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society
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Affiliation(s)
- Frouke A P Nijhuis
- Department of Neurology, Canisius Wilhelmina Hospital, Nijmegen, the Netherlands.,Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behavior, Nijmegen, the Netherlands
| | - Rianne Esselink
- Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behavior, Nijmegen, the Netherlands
| | - Rob M A de Bie
- Department of Neurology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Neuroscience, Amsterdam, the Netherlands
| | - Hans Groenewoud
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Bastiaan R Bloem
- Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behavior, Nijmegen, the Netherlands
| | - Bart Post
- Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behavior, Nijmegen, the Netherlands
| | - Marjan J Meinders
- Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behavior, Nijmegen, the Netherlands
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Initial Experience of the Levodopa-Entacapone-Carbidopa Intestinal Gel in Clinical Practice. J Pers Med 2021; 11:jpm11040254. [PMID: 33807308 PMCID: PMC8067183 DOI: 10.3390/jpm11040254] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 03/25/2021] [Accepted: 03/30/2021] [Indexed: 11/17/2022] Open
Abstract
Patients in fluctuating stages of Parkinson’s disease (PD) require device-aided treatments. Continuous infusion of levodopa–carbidopa intestinal gel (LCIG) is a well-proven option in clinical practice. We now report the first clinical experience of levodopa–entacapone–carbidopa intestinal gel (LECIG) therapy. An observational study of the first patients to start LECIG in our clinic was performed. Twenty-four patients (11 females, 13 males) were included. The median age was 71.5 years, and the median duration since PD diagnosis was 15.5 years. The median treatment duration was 305 days. Median doses were: 6.0 mL as morning dose, 2.5 mL/h as infusion rate, and 1.0 mL as extra dose. Half of the patients were switched directly from LCIG. These patients express improvements in the size and weight of the pump. Furthermore, most of them considered the new pump to be improved regarding user-friendliness. Six patients discontinued LECIG, three due to diarrhea, one due to hallucinations and two deceased (one cardiac arrest and one COVID-19). LECIG has shown to be possible to use in patients with PD, efficacy and safety as expected. Patients are generally happy with the size and usability of the pump, but some technical improvements of the software are warranted, as well as larger, prospective studies.
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Kamel WA, Al-Hashel JY. LCIG in treatment of non-motor symptoms in advanced Parkinson's disease: Review of literature. Brain Behav 2020; 10:e01757. [PMID: 32677345 PMCID: PMC7507541 DOI: 10.1002/brb3.1757] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 05/19/2020] [Accepted: 06/28/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND For managing nonmotor symptoms (NMS) in advanced Parkinson's disease (PD), levodopa-carbidopa intestinal gel (LCIG) infusion is of interest as it shows lesser plasma fluctuations of both drugs as compared to oral levodopa-carbidopa (LC). OBJECTIVES To highlight LCIG effect in NMS among advanced PD patients and appraise the currently available literature. METHODS PubMed screening (till 2020) of 184 articles was done, of which 51 were selected. Among them, 23 original articles relevant to the research question were included, of which 6 were then excluded after careful reading of full articles. The 17 relevant studies of the review provide Grade C level of evidence of efficacy. RESULTS LCIG is beneficial in improving or relieving various NMS especially (mood, cognition/memory, sleep, gastrointestinal symptoms, urinary symptoms, and quality of life questionnaires) in patients with advanced PD. Amelioration of motor functions or direct relations may lead to improvement in NMS PD patients using LCIG. Adverse events noted in patients treated with LCIG include pneumoperitoneum, abdominal pain, stoma infection, reversible peripheral neuropathy, local tube problems, impulse control disorder, and weight loss. Serious adverse events were mostly found to be unrelated to LCIG. CONCLUSIONS LCIG provides an uninterrupted intestinal levodopa infusion by percutaneous endoscopic gastrojejunostomy (PEG-J). It effectively decreases plasma fluctuations of levodopa and reduces motor instability and NMS burden in advanced PD. However, adequate dose modification and individualization of therapy are essential for optimal effect.
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Affiliation(s)
- Walaa A Kamel
- Neurology Department, Ibn-Sina Hospital, Kuwait City, Kuwait.,Neurology Department, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt
| | - Jasem Y Al-Hashel
- Neurology Department, Ibn-Sina Hospital, Kuwait City, Kuwait.,Department of Medicine, Faculty of Medicine, Kuwait University, Kuwait City, Kuwait
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6
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Antonini A, Marano P, Gusmaroli G, Modugno N, Pacchetti C, Sensi M, Melzi G, Bergmann L, Zibetti M, Lopiano L. Long-term effectiveness of levodopa-carbidopa intestinal gel on motor and non-motor symptoms in advanced Parkinson's disease: results of the Italian GLORIA patient population. Neurol Sci 2020; 41:2929-2937. [PMID: 32342325 PMCID: PMC7479015 DOI: 10.1007/s10072-020-04401-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 04/07/2020] [Indexed: 12/29/2022]
Abstract
Introduction The GLORIA registry included 375 advanced Parkinson’s disease (PD) patients and evaluated the efficacy and safety of a 24-month levodopa-carbidopa intestinal gel (LCIG) treatment in routine medical care. This analysis focuses on the Italian population, 60 patients treated with LCIG in 7 specialised PD care centres. Methods Hours of “Off” and “On” time were assessed with a modified version of the Unified Parkinson’s Disease Rating Scale (UPDRS) part IV items 39 and 32. Motor fluctuations, dyskinesia, non-motor symptoms, quality of life and safety were evaluated. Results Overall, 42 (70%) out of 60 patients completed the registry. LCIG treatment reduced “Off” time (− 3.3 ± 2.7 h at month 24 (M24), P < 0.0001), increased “On” time with dyskinesia (− 2.6 ± 5.2 h at M12, P = 0.0160), and improved UPDRS II and UPDRS III total scores at M24 (− 4.5 ± 10.6, P = 0.0333 and − 4.9 ± 11.7, P = 0.0229, respectively), Non-Motor Symptom Scale (NMSS) total score (− 21.8 ± 28.5, P < 0.0001) and Parkinson’s Disease Questionnaire-8 item (PDQ-8) total score (− 12.5 ± 23.9, P = 0.0173) versus previous oral therapy. Adverse drug reactions (ADR) possibly or probably related to treatment were reported in 16 (28.6%) patients. Decreased weight (7.1%), polyneuropathy (7.1%) and abdominal pain (5.4%) were the most frequent ADRs while device malfunction (5.4%) and medical device change (5.4%) were the most reported device complaints. Conclusions LCIG improved motor fluctuations, non-motor symptoms and quality of life over 24 months while tolerability was consistent with the established safety profile.
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Affiliation(s)
- Angelo Antonini
- Parkinson and Movement Disorders Unit, Department of Neuroscience, University of Padua, Padua, Italy.
| | | | | | | | - Claudio Pacchetti
- Parkinson's Disease and Movement Disorders Unit, IRCCS C. Mondino Foundation, Pavia, Italy
| | | | - Gabriella Melzi
- Medical Department, AbbVie s.r.l., Campoverde di Aprilia, Italy
| | | | - Maurizio Zibetti
- Department of Neuroscience, University of Torino, AOU Città della Salute e della Scienza, Torino, Italy
| | - Leonardo Lopiano
- Department of Neuroscience, University of Torino, AOU Città della Salute e della Scienza, Torino, Italy
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Sleep Quality and Levodopa Intestinal Gel Infusion in Parkinson's Disease: A Pilot Study. PARKINSONS DISEASE 2018; 2018:8691495. [PMID: 30515291 PMCID: PMC6236977 DOI: 10.1155/2018/8691495] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 09/08/2018] [Accepted: 10/14/2018] [Indexed: 11/18/2022]
Abstract
Background Sleep problems in patients with advanced Parkinson's disease (PD) have a deleterious impact on quality of life. Objective To assess the effect of levodopa-carbidopa intestinal gel (LCIG) infusion on sleep quality in advanced PD patients. Methods Seven patients participated in a prospective pilot study. Before and after 6 months of LCIG infusion, an overnight polysomnography was performed and the Epworth Sleepiness Scale, fatigue scale, Pittsburgh Sleep Quality Index, Beck Depression Inventory, and the Hamilton Anxiety Rating Scale were administered. Results PSG showed low sleep efficiency. REM sleep without atony was found in 5 patients. After 6 months of LCIG infusion, the percentage of REM sleep decreased as well as the number of arousals especially due to reduction of spontaneous arousals and periodic leg movements during REM sleep, but differences were not statistically significant. Also, scores of all study questionnaires showed a tendency to improve. Conclusion The results show a trend toward an improvement of sleep quality after 6 months of LCIG infusion, although differences as compared to pretreatment values were not statistically significant. The sleep architecture was not modified by LCIG. Further studies with larger study samples are needed to confirm these preliminary findings.
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8
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Cerrone P, Marchese M, Pistoia MA, Marini C. Phytobezoar and duodenal ulcer as complication of Duodopa therapy in a patient affected by Parkinson's disease. BMJ Case Rep 2018; 2018:bcr-2017-223884. [PMID: 29960957 DOI: 10.1136/bcr-2017-223884] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Continuous duodenal infusion of levodopa/carbidopa intestinal gel (LCIG) is an established treatment to control motor fluctuations in Parkinson's disease. Duodenal infusion allows a steady absorption of the drug in the small bowel, reducing plasmatic fluctuations of levodopa. Some complications may occur during the treatment, often related to intrajejunal percutaneous endoscopic gastrostomy (PEG-J). We report a case of duodenal ulcer associated with a phytobezoar involving the end of jejunal probe, in a patient who underwent PEG-J for LCIG infusion. In the last 2 weeks, the patient suffered from abdominal pain and dyspepsia. Oesophagogastroduodenoscopy showed an ulcerative lesion of the duodenum due to traction of the jejunal tube; the end of the jejunal tube was wrapped in a phytobezoar. This case is interesting because of the extension of the ulcerative lesion due to PEG-J dislocation and because of the subtle symptoms associated with it.
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Affiliation(s)
- Paolo Cerrone
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy.,ASL 1 Avezzano Sulmona l'Aquila, Neurology Unit, San Salvatore Hospital, L'Aquila, Italy
| | - Michele Marchese
- ASL 1 Avezzano, Sulmona L'Aquila, Surgical and Diagnostic Endoscopy Unit, San Salvatore Hospital, L'Aquila, Italy
| | - Maria Antonietta Pistoia
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy.,ASL 1 Avezzano, Sulmona L'Aquila, Surgical and Diagnostic Endoscopy Unit, San Salvatore Hospital, L'Aquila, Italy
| | - Carmine Marini
- ASL 1 Avezzano Sulmona l'Aquila, Neurology Unit, San Salvatore Hospital, L'Aquila, Italy.,Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
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9
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Ciurleo R, Corallo F, Bonanno L, Lo Buono V, Di Lorenzo G, Versaci R, Allone C, Palmeri R, Bramanti P, Marino S. Assessment of Duodopa ® effects on quality of life of patients with advanced Parkinson's disease and their caregivers. J Neurol 2018; 265:2005-2014. [PMID: 29951701 DOI: 10.1007/s00415-018-8951-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 05/06/2018] [Accepted: 06/20/2018] [Indexed: 12/25/2022]
Abstract
The gold standard of treatment in Parkinson's disease (PD) is levodopa/carbidopa whose long-term use induces motor and non-motor fluctuations and dyskinesias. Continuous infusion of intrajejunal levodopa/carbidopa intestinal gel (Duodopa®) reduces motor and non-motor symptoms and dyskinesias, and improves the quality of life of patients. The aim of this open observational prospective study was to evaluate the impact of Duodopa® on conditions of PD patients and caregivers, and their quality of life. We enrolled 12 patients with advanced PD and their caregivers. The PD patients were assessed at baseline, 3 and 6 months after Duodopa® treatment initiation using Unified Parkinson's Disease Rating Scale-Part III and IV (UPDRS-III and IV), Unified Dyskinesia Rating Scale (UdysRS), Beck Depression Inventory (BDI-II), Hamilton Anxiety Rating Scale (HAM-A) and Parkinson's Disease Quality of Life Questionnaire (PDQ-39). The caregivers were assessed, at the same time as the patients, using BDI-II, HAM-A, Caregiver Burden Inventory (CBI) and SF-36 Health Status Questionnaire. Six months after Duodopa® therapy, the scores of UPDRS-III and IV, UdysRS, BDI-II, HAM-A and PDQ-39 were significantly decreased (p < 0.01). After Duodopa® therapy, in caregiver group the scores of BDI-II, HAM-A and CBI were significantly decreased and the scores of SF-36 Health Status Questionnaire were significantly increased (p < 0.01). A reduction of anxiety after therapy correlated with mental status domains of SF-36 Health Status Questionnaire (r = 0.56). Overall, Duodopa® is effective even in the short time to improve the clinical conditions of PD patients and caregivers and their quality of life.
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Affiliation(s)
- Rosella Ciurleo
- IRCCS Centro Neurolesi "Bonino-Pulejo", S.S. 113, Via Palermo, C.da Casazza, 98124, Messina, Italy.
| | - Francesco Corallo
- IRCCS Centro Neurolesi "Bonino-Pulejo", S.S. 113, Via Palermo, C.da Casazza, 98124, Messina, Italy
| | - Lilla Bonanno
- IRCCS Centro Neurolesi "Bonino-Pulejo", S.S. 113, Via Palermo, C.da Casazza, 98124, Messina, Italy
| | - Viviana Lo Buono
- IRCCS Centro Neurolesi "Bonino-Pulejo", S.S. 113, Via Palermo, C.da Casazza, 98124, Messina, Italy
| | - Giuseppe Di Lorenzo
- IRCCS Centro Neurolesi "Bonino-Pulejo", S.S. 113, Via Palermo, C.da Casazza, 98124, Messina, Italy
| | - Roberta Versaci
- IRCCS Centro Neurolesi "Bonino-Pulejo", S.S. 113, Via Palermo, C.da Casazza, 98124, Messina, Italy
| | - Cettina Allone
- IRCCS Centro Neurolesi "Bonino-Pulejo", S.S. 113, Via Palermo, C.da Casazza, 98124, Messina, Italy
| | - Rosanna Palmeri
- IRCCS Centro Neurolesi "Bonino-Pulejo", S.S. 113, Via Palermo, C.da Casazza, 98124, Messina, Italy
| | - Placido Bramanti
- IRCCS Centro Neurolesi "Bonino-Pulejo", S.S. 113, Via Palermo, C.da Casazza, 98124, Messina, Italy
| | - Silvia Marino
- IRCCS Centro Neurolesi "Bonino-Pulejo", S.S. 113, Via Palermo, C.da Casazza, 98124, Messina, Italy.,Department of Biomedical and Dental Sciences and Morphological and Functional Imaging, University of Messina, Via Consolare Valeria n. 1, 98125, Messina, Italy
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Willows T, Dizdar N, Nyholm D, Widner H, Grenholm P, Schmiauke U, Urbom A, Groth K, Larsson J, Permert J, Kjellander S. Initiation of Levodopa-Carbidopa Intestinal Gel Infusion Using Telemedicine (Video Communication System) Facilitates Efficient and Well-Accepted Home Titration in Patients with Advanced Parkinson's Disease. JOURNAL OF PARKINSONS DISEASE 2018; 7:719-728. [PMID: 28984615 PMCID: PMC5676855 DOI: 10.3233/jpd-161048] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background: Levodopa-carbidopa intestinal gel (LCIG; Duodopa®) is used for continuous infusion in advanced Parkinson’s disease. To achieve optimal effect, the LCIG dose is individually titrated, traditionally conducted during hospitalization in Sweden. However, dose adjustment depends on surrounding conditions, physical activity, and emotional stress, which is why titration at home could be beneficial. Telemedicine (TM) using a video communication system offers alternative titration procedures, allowing LCIG initiation at home. Objective: Study objectives were to show the feasibility of TM for LCIG home titration, evaluate resource use, and assess patient, neurologist, and nurse satisfaction. Methods: Four clinics enrolled 15 patients to observe efficiency and feasibility of TM-based monitoring. Results: Patient median (range) age was 67 (52–73) years and time since diagnosis was 10 (7–23) years. Median time between LCIG initiation and end of TM-assisted titration was 2.8 (2.0–13.8) days. Median time required for home titration by neurologists, nurses, and patients was (hours:minutes) 1 : 14 (0 : 29–1 : 52), 5 : 49 (2 : 46–10 : 3), and 8 : 53 (4 : 11–14 : 11), respectively. Neurologists and nurses considered this to be less time than required for hospital titration. TM allowed patients 92% free time from start to end of titration. Technical problems associated with TM contacts were rare, mostly related to digital link, and quickly resolved. Patients, neurologists, and nurses were satisfied using TM. No serious adverse events were reported; there was one device complaint (tube occlusion). Conclusions: In this study, TM-assisted LCIG titration at home was resource-efficient, technically feasible, well-accepted and was deemed satisfactory by patients, neurologists, and nurses.
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Affiliation(s)
- Thomas Willows
- Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
| | - Nil Dizdar
- Department of Neurology, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Dag Nyholm
- Department of Neuroscience, Neurology, Uppsala University, Uppsala, Sweden
| | - Håkan Widner
- Department of Neurology, Skåne University Hospital, Lund, Sweden
| | - Peter Grenholm
- Department of Neuroscience, Neurology, Uppsala University, Uppsala, Sweden
| | - Ursula Schmiauke
- Department of Neurology, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | | | - Kristina Groth
- Innovation Center, Karolinska University Hospital, Stockholm, Sweden.,Clintec, Karolinska Institutet, Stockholm, Sweden
| | - Jörgen Larsson
- Innovation Center, Karolinska University Hospital, Stockholm, Sweden.,Clintec, Karolinska Institutet, Stockholm, Sweden
| | - Johan Permert
- Innovation Center, Karolinska University Hospital, Stockholm, Sweden.,Clintec, Karolinska Institutet, Stockholm, Sweden
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Catalán MJ, Antonini A, Calopa M, Băjenaru O, de Fábregues O, Mínguez-Castellanos A, Odin P, García-Moreno JM, Pedersen SW, Pirtošek Z, Kulisevsky J. Can suitable candidates for levodopa/carbidopa intestinal gel therapy be identified using current evidence? eNeurologicalSci 2017; 8:44-53. [PMID: 29260038 PMCID: PMC5730910 DOI: 10.1016/j.ensci.2017.06.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 06/26/2017] [Indexed: 01/24/2023] Open
Abstract
Advanced Parkinson's disease (APD) is characterized by increased functional disability, caused by motor complications, the presence of axial symptoms, and emergent disease- and drug-related non-motor symptoms. One of the advanced therapies available is intrajejunal infusion of levodopa/carbidopa intestinal gel (LCIG); however, patient selection for this treatment is sometimes difficult, particularly because of overlapping indications with other alternatives. In recent years, strong evidence has supported the use of LCIG in treating motor fluctuations associated with APD, and several clinical studies provide emerging evidence for additional benefits of LCIG treatment in certain patients. This article provides an overview of the published literature on the benefits, limitations, and drawbacks of LCIG in relation to PD symptoms, the psychosocial impact of the disease, and the quality of life of patients, with the aim of determining candidates for whom treatment with LCIG would be beneficial. According to current evidence, patients with APD (defined as inability to achieve optimal control of the disease with conventional oral treatment), a relatively well-preserved cognitive-behavioral status, and good family/caregiver would count as suitable candidates for LCIG treatment. Contraindications in the opinion of the authors are severe dementia and active psychosis.
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Key Words
- APD, Advanced Parkinson's disease
- DBS, Deep brain stimulation
- Duodopa
- ICD, Impulse control disorders
- Intrajejunal infusion of levodopa/carbidopa intestinal gel
- LCIG, Levodopa-carbidopa intestinal gel
- Motor symptoms
- NMS, Non-motor symptoms
- NMSS, Non-motor symptoms scale
- Non-motor symptoms
- PD, Parkinson's disease
- PDSS, Parkinson's disease sleep scale
- PEG, Percutaneous endoscopic gastrostomy
- Parkinson's disease
- QoL, Quality of life
- Quality of life
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Affiliation(s)
- Maria José Catalán
- Parkinson and Movement Disorders Unit, Hospital Clínico San Carlos, Madrid, Spain
| | - Angelo Antonini
- Parkinson and Movement Disorders Unit, Department of Neurosciences, IRCCS Hospital San Camillo, Venice, Italy
| | | | - Ovidiu Băjenaru
- University of Medicine and Pharmacy "Carol Davila" Bucharest - University Emergency Hospital, Department of Neurology, Bucharest, Romania
| | - Oriol de Fábregues
- Vall d'Hebron University Hospital, Neurology Service, Movement Disorders Unit, Autonomous University of Barcelona, Neurodegenerative Diseases Research Group, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Adolfo Mínguez-Castellanos
- Complejo Hospitalario Universitario de Granada, Instituto de Investigación Biosanitaria "ibs. Granada,", Granada, Spain
| | - Per Odin
- Skåne University Hospital, Lund University, Lund, Sweden.,Klinikum-Bremerhaven, Bremerhaven, Germany
| | | | | | | | - Jaime Kulisevsky
- Hospital Santa Creu i Sant Pau, Ciberned, Universitat Autònoma de Barcelona, Universitat Oberta de Catalunya, Barcelona, Spain
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Antonini A, Poewe W, Chaudhuri KR, Jech R, Pickut B, Pirtošek Z, Szasz J, Valldeoriola F, Winkler C, Bergmann L, Yegin A, Onuk K, Barch D, Odin P, Amalia E, Arnold G, Bajenaru O, Bergmans B, Bjornara KA, Blackie J, Bode M, Bourgeois P, Bohlhalter S, Buraga I, Burkhard PR, Busson P, Calopa M, Clausen J, Danielsen EH, Defebvre L, Delvaux V, Dethy S, Dietrichs E, De Fabregues O, Gerhard R, Gusmaroli G, Hahn K, Hauptmann B, Henriksen T, Hernandez-Vara J, Jeanjean A, Kaiserova M, Kassubek J, Kimber T, Konitsiotis S, Krüger R, Kulisevsky J, Leenders J, Lundqvist C, Ory Magne F, Marano P, Milanov I, Modugno N, Misbahuddin A, Nevrly M, Panayiotis Z, Pedersen KF, Pedersen SW, Perju-Dumbrava L, Ponsen M, Popescu BO, Rijntjes M, Puente V, Redecker C, Schrader C, Sensi M, Simu M, Spanaki C, Storch A, Storstein A, Tomantschger V, van der Linden C, van Laar T, Viallet F, Witjas T, Wolz M, Zibetti M, Van Zandijcke M. Levodopa-carbidopa intestinal gel in advanced Parkinson's: Final results of the GLORIA registry. Parkinsonism Relat Disord 2017; 45:13-20. [DOI: 10.1016/j.parkreldis.2017.09.018] [Citation(s) in RCA: 109] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 08/16/2017] [Accepted: 09/18/2017] [Indexed: 11/24/2022]
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13
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Feasibility of spirography features for objective assessment of motor function in Parkinson's disease. Artif Intell Med 2017; 81:54-62. [DOI: 10.1016/j.artmed.2017.03.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Accepted: 03/28/2017] [Indexed: 11/20/2022]
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14
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De Fabregues O, Dot J, Abu-Suboh M, Hernández-Vara J, Ferré A, Romero O, Ibarria M, Seoane JL, Raguer N, Puiggros C, Gómez MR, Quintana M, Armengol JR, Alvarez-Sabín J. Long-term safety and effectiveness of levodopa-carbidopa intestinal gel infusion. Brain Behav 2017; 7:e00758. [PMID: 28828219 PMCID: PMC5561319 DOI: 10.1002/brb3.758] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 05/26/2017] [Accepted: 06/04/2017] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Levodopa-carbidopa intestinal gel (LCIG) infusion has demonstrated to improve motor fluctuations. The aim of this study is to assess the long-term safety and effectiveness of LCIG infusion in advanced Parkinson's disease (PD) patients with motor fluctuations and its effect in nonmotor symptoms. METHODS Adverse events (AE) and their management, clinical motor, and nonmotor aspects were assessed up to 10 years. Thirty-seven patients were treated with LGIC; in three subsets of patients, specific batteries of tests were used to assess cognitive and behavior assessment for 6 months, quality of sleep for 6 months, and quality of life and caregiver burden for 1 year. RESULTS There was a high number of AE, but manageable, most of mild and moderate severity. All patients experienced significant improvement in motor fluctuations with a reduction in mean daily off time of 4.87 hr after 3 months (n = 37) to 6.25 hr after 9 years (n = 2). Diskynesias remained stables in 28 patients (75.7%) and improved in 5 patients (13.5%). There was no neuropsychological deterioration, but an improvement in attentional functions, voluntary motor control, and semantic fluency. Quality of sleep did not worsen, and there was an improvement in the subjective parameters, although overnight polysomnography did not change. There was a significant sustained improvement of 37% in PD-Q39 after 3 months and to 1 year, and a significant reduction in caregiver burden of 10% after 3 months. CONCLUSION LCIG infusion is a safe and efficacious treatment for the control of motor fluctuations, and for improvement or nonworsening of nonmotor aspects, long-term sustained, and feasible for use in routine care.
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Affiliation(s)
- Oriol De Fabregues
- Movement Disorders Unit Neurology Department Vall d'Hebron University Hospital Neurodegenerative Diseases Research Group-Vall d'Hebron Research Institute Autonomous University of Barcelona Barcelona Spain
| | - Joan Dot
- Digestive Endoscopy Department Vall d'Hebron University Hospital Barcelona Spain
| | - Monder Abu-Suboh
- Digestive Endoscopy Department Vall d'Hebron University Hospital Barcelona Spain
| | - Jorge Hernández-Vara
- Movement Disorders Unit Neurology Department Vall d'Hebron University Hospital Neurodegenerative Diseases Research Group-Vall d'Hebron Research Institute Autonomous University of Barcelona Barcelona Spain
| | - Alex Ferré
- Sleep Unit Neurophysiology Department Vall d'Hebron University Hospital Barcelona Spain
| | - Odile Romero
- Sleep Unit Neurophysiology Department Vall d'Hebron University Hospital Barcelona Spain
| | - Marta Ibarria
- Movement Disorders Unit Neurology Department Vall d'Hebron University Hospital Neurodegenerative Diseases Research Group-Vall d'Hebron Research Institute Autonomous University of Barcelona Barcelona Spain
| | - José Luis Seoane
- Electromyography Unit Neurophysiology Department Vall d'Hebron University Hospital Barcelona Spain
| | - Nuria Raguer
- Electromyography Unit Neurophysiology Department Vall d'Hebron University Hospital Barcelona Spain
| | - Carolina Puiggros
- Nutritional Support Department Vall d'Hebron University Hospital Barcelona Spain
| | - Maria Rosa Gómez
- Pharmacy Department Vall d'Hebron University Hospital Barcelona Spain
| | - Manuel Quintana
- Movement Disorders Unit Neurology Department Vall d'Hebron University Hospital Neurodegenerative Diseases Research Group-Vall d'Hebron Research Institute Autonomous University of Barcelona Barcelona Spain
| | - Josep Ramon Armengol
- Digestive Endoscopy Department Vall d'Hebron University Hospital Barcelona Spain
| | - José Alvarez-Sabín
- Movement Disorders Unit Neurology Department Vall d'Hebron University Hospital Neurodegenerative Diseases Research Group-Vall d'Hebron Research Institute Autonomous University of Barcelona Barcelona Spain
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Mundt-Petersen U, Odin P. Infusional Therapies, Continuous Dopaminergic Stimulation, and Nonmotor Symptoms. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2017; 134:1019-1044. [DOI: 10.1016/bs.irn.2017.05.036] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/17/2023]
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Virhammar J, Nyholm D. Levodopa-carbidopa enteral suspension in advanced Parkinson's disease: clinical evidence and experience. Ther Adv Neurol Disord 2016; 10:171-187. [PMID: 28344656 DOI: 10.1177/1756285616681280] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The duration of action of oral levodopa becomes shorter as Parkinson's disease (PD) progresses. Patients with advanced PD may develop potentially disabling motor fluctuations and abnormal involuntary movement (dyskinesia), which cannot be managed with optimized oral or transdermal PD medications. The progressively worsening symptoms can have a substantial impact on the patient quality of life (QoL). Levodopa-carbidopa intestinal gel (LCIG) is delivered continuously via a percutaneous endoscopic gastrostomy with a jejunal extension (PEG-J). LCIG is licensed for the treatment of levodopa-responsive advanced PD in individuals experiencing severe motor fluctuations and dyskinesia when available combinations of antiparkinsonian medications have not given satisfactory results. Initial evidence for the efficacy and tolerability of LCIG came from a number of small-scale studies, but recently, three prospective studies have provided higher quality evidence. A 12-week double-blind comparison of LCIG with standard levodopa therapy, a 52-week open-label study extension of the double-blind study, and a 54-week open-label safety study, demonstrated significant improvements in 'off' time and 'on' time without troublesome dyskinesia, and QoL measures that were maintained in the longer term. There are also observations that LCIG may be effective treatment for nonmotor symptoms (NMS) although the evidence is limited. There is a need for further research on the efficacy of LCIG in reducing NMS, dyskinesia and improving QoL. This review surveys the clinical evidence for the effectiveness and tolerability of LCIG in the management of advanced PD and highlights some practical considerations to help optimize treatment.
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Affiliation(s)
- Johan Virhammar
- Department of Neuroscience, Neurology, Uppsala University, Uppsala, Sweden
| | - Dag Nyholm
- Department of Neuroscience, Neurology, Uppsala University Hospital, 751 85 Uppsala, Sweden
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Martino T, Melchionda D, Tonti P, De Francesco V, Lalla A, Specchio LM, Avolio C. Weight loss and decubitus duodenal ulcer in Parkinson’s disease treated with levodopa–carbidopa intestinal gel infusion. J Neural Transm (Vienna) 2016; 123:1395-1398. [PMID: 27614656 DOI: 10.1007/s00702-016-1618-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 09/04/2016] [Indexed: 11/24/2022]
Affiliation(s)
- Tommaso Martino
- SC Neurologia Universitaria-AOU Ospedali Riuniti of Foggia, Foggia, Italy.
| | - Donato Melchionda
- SC Neurologia Universitaria-AOU Ospedali Riuniti of Foggia, Foggia, Italy
| | - Paolo Tonti
- Gastroenterology Unit-AOU Ospedali Riuniti of Foggia, Foggia, Italy
| | | | - Alessandra Lalla
- SC Neurologia Universitaria-AOU Ospedali Riuniti of Foggia, Foggia, Italy
| | | | - Carlo Avolio
- SC Neurologia Universitaria-AOU Ospedali Riuniti of Foggia, Foggia, Italy
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18
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Pålhagen SE, Sydow O, Johansson A, Nyholm D, Holmberg B, Widner H, Dizdar N, Linder J, Hauge T, Jansson R, Bergmann L, Kjellander S, Marshall TS. Levodopa-carbidopa intestinal gel (LCIG) treatment in routine care of patients with advanced Parkinson’s disease: An open-label prospective observational study of effectiveness, tolerability and healthcare costs. Parkinsonism Relat Disord 2016; 29:17-23. [DOI: 10.1016/j.parkreldis.2016.06.002] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 05/11/2016] [Accepted: 06/02/2016] [Indexed: 12/27/2022]
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Fundament T, Eldridge PR, Green AL, Whone AL, Taylor RS, Williams AC, Schuepbach WMM. Deep Brain Stimulation for Parkinson's Disease with Early Motor Complications: A UK Cost-Effectiveness Analysis. PLoS One 2016; 11:e0159340. [PMID: 27441637 PMCID: PMC4956248 DOI: 10.1371/journal.pone.0159340] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Accepted: 06/30/2016] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Parkinson's disease (PD) is a debilitating illness associated with considerable impairment of quality of life and substantial costs to health care systems. Deep brain stimulation (DBS) is an established surgical treatment option for some patients with advanced PD. The EARLYSTIM trial has recently demonstrated its clinical benefit also in patients with early motor complications. We sought to evaluate the cost-effectiveness of DBS, compared to best medical therapy (BMT), among PD patients with early onset of motor complications, from a United Kingdom (UK) payer perspective. METHODS We developed a Markov model to represent the progression of PD as rated using the Unified Parkinson's Disease Rating Scale (UPDRS) over time in patients with early PD. Evidence sources were a systematic review of clinical evidence; data from the EARLYSTIM study; and a UK Clinical Practice Research Datalink (CPRD) dataset including DBS patients. A mapping algorithm was developed to generate utility values based on UPDRS data for each intervention. The cost-effectiveness was expressed as the incremental cost per quality-adjusted life-year (QALY). One-way and probabilistic sensitivity analyses were undertaken to explore the effect of parameter uncertainty. RESULTS Over a 15-year time horizon, DBS was predicted to lead to additional mean cost per patient of £26,799 compared with BMT (£73,077/patient versus £46,278/patient) and an additional mean 1.35 QALYs (6.69 QALYs versus 5.35 QALYs), resulting in an incremental cost-effectiveness ratio of £19,887 per QALY gained with a 99% probability of DBS being cost-effective at a threshold of £30,000/QALY. One-way sensitivity analyses suggested that the results were not significantly impacted by plausible changes in the input parameter values. CONCLUSION These results indicate that DBS is a cost-effective intervention in PD patients with early motor complications when compared with existing interventions, offering additional health benefits at acceptable incremental cost. This supports the extended use of DBS among patients with early onset of motor complications.
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Affiliation(s)
| | - Paul R. Eldridge
- The Walton Centre NHS Foundation Trust and Liverpool University, Liverpool, United Kingdom
| | - Alexander L. Green
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom
| | - Alan L. Whone
- Bristol Brain Centre, Southmead Hospital, Bristol, United Kingdom
| | - Rod S. Taylor
- University of Exeter Medical School, Exeter, United Kingdom
| | - Adrian C. Williams
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - W. M. Michael Schuepbach
- Movement Disorders Center, Department of Neurology, Bern University Hospital and University of Bern, Bern, Switzerland
- Assistance Publique Hôpitaux de Paris, Centre d’Investigation Clinique 9503, Institut du Cerveau et de la Moelle épinière, Département de Neurologie, Université Pierre et Marie Curie–Paris 6 et INSERM, CHU Pitié-Salpêtrière, Paris, France
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Abstract
BACKGROUND Levodopa-carbidopa intestinal gel (LCIG) is available in several countries for the treatment of advanced levodopa-responsive Parkinson's disease (PD) with severe motor fluctuations and dyskinesia when other treatments have not given satisfactory results. OBJECTIVE Our objective was to summarize the present evidence base for LCIG therapy through a systematic review of the literature. METHODS Studies were identified from the PubMed and EMBASE databases up to 12 March 2016 using the following search terms: Parkinson disease, duodopa, levodopa/carbidopa intestinal gel, levodopa-carbidopa intestinal gel, LCIG, l-dopa infusion, levodopa infusion, duodenal l-dopa infusion, and duodenal levodopa infusion. Data extraction focused on whether LCIG therapy improves motor and non-motor outcomes as well as quality of life in PD patients compared with conventional therapy, apomorphine infusion, or deep brain stimulation. Randomized controlled trials (RCTs) and observational studies, with or without a control group, that included more than ten patients were included. The search was limited to peer-reviewed articles published in full in the English language and involving humans. RESULTS Infusion of LCIG reduced "off" time, increased "on" time without increasing troublesome dyskinesias, and improved quality of life in three RCTs (one double-blind). Open-label follow-ups confirm these findings. The data evaluating long-term efficacy and safety are still limited. CONCLUSIONS The quality of evidence that LCIG is effective in reducing fluctuating motor symptoms and improving quality of life is moderate. Quality of evidence for reduction of non-motor symptoms is very low. Safety issues mainly relate to the intestinal infusion system. LCIG might be a useful treatment option in PD patients with severe motor fluctuations.
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Santos García D, Martínez Castrillo JC, Puente Périz V, Seoane Urgorri A, Fernández Díez S, Benita León V, Udaeta Baldivieso B, Campolongo Perillo A, Mariscal Pérez N. Clinical management of patients with advanced Parkinson's disease treated with continuous intestinal infusion of levodopa/carbidopa. Neurodegener Dis Manag 2016; 6:187-202. [PMID: 27075968 DOI: 10.2217/nmt-2016-0011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Patients with Parkinson's disease often have a good initial response to dopaminergic therapy but later usually develop motor fluctuations and dyskinesia. In these patients, continuous infusion of levodopa-carbidopa intestinal gel (LCIG) allows for maintaining adequate dopamine levels and for improving motor and nonmotor symptoms, as well as quality of life and autonomy. Adequate candidate selection and follow-up are crucial for treatment success. Management should be multidisciplinary, and patient and caregiver education is a priority. This expert consensus document has been developed by a team of neurologists, gastroenterologists and nurses who have a vast experience in LCIG therapy, with an intention to provide knowledge and tools to facilitate patient management throughout all phases of LCIG treatment process.
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Affiliation(s)
- Diego Santos García
- Section of Neurology, Hospital Arquitecto Marcide, Ferrol University Hospital Complex (CHUF), Ferrol, Spain
| | | | | | - Agustín Seoane Urgorri
- Section of Gastrointestinal Endoscopy, Department of Gastroenterology, Hospital del Mar, Barcelona, Spain
| | | | | | - Beatriz Udaeta Baldivieso
- Unit of Movement Disorders & Parkinson's Disease, Gran Canaria University Hospital, Las Palmas de Gran Canaria, Spain
| | - Antonia Campolongo Perillo
- Department of Neurology, Movement Disorders Unit, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.,Department of Health Sciences, Universitat Oberta de Catalunya (UOC), Barcelona, Spain
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Abstract
INTRODUCTION The search for consistent, effective treatments in Parkinson's disease (PD) is ongoing. The importance of continuous dopaminergic stimulation (CDS) is understood to underlie best medical therapy for PD by providing closer replication of physiological patterns of dopamine release in healthy brains. AREAS COVERED An overview of interventions to improve motor fluctuations in PD is presented. Significant improvements in off-time are achieved by providing continuous therapy using targeted deep brain stimulation (DBS), subcutaneous apomorphine infusion and carbidopa/levodopa enteral suspension (Duopa). Duopa is a newly approved treatment in the US for advanced PD that delivers levodopa pumped to the intestinal tract through a percutaneous gastrostomy with jejunum tube extension (PEG-J tube). Trials with carbidopa/levodopa enteral suspension show improvement in motor fluctuations, reduction in plasma levodopa variation and improvement in overall "on" time compared with oral immediate release formulation of carbidopa/levodopa. EXPERT OPINION The degree of improvement in number of off hours per day on carbidopa/levodopa enteral suspension infusion rivals that seen with DBS and apomorphine infusion and makes this new treatment a valuable option in advanced fluctuating PD patients, especially those who are neither candidates for DBS or who do not have access to apomorphine infusion therapy or who have failed either or both therapies.
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Affiliation(s)
- Lauren C Seeberger
- a Department of Neurology , University of Colorado , Denver , CO 80045 , USA
| | - Robert A Hauser
- b Department of Neurology , Molecular Pharmacology and Physiology, University of South Florida , Tampa , FL 33613 , USA
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Memedi M, Nyholm D, Johansson A, Palhagen S, Willows T, Widner H, Linder J, Westin J. Validity and Responsiveness of At-Home Touch Screen Assessments in Advanced Parkinson's Disease. IEEE J Biomed Health Inform 2015; 19:1829-34. [DOI: 10.1109/jbhi.2015.2468088] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Automatic Spiral Analysis for Objective Assessment of Motor Symptoms in Parkinson's Disease. SENSORS 2015; 15:23727-44. [PMID: 26393595 PMCID: PMC4610483 DOI: 10.3390/s150923727] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 09/03/2015] [Accepted: 09/09/2015] [Indexed: 12/03/2022]
Abstract
A challenge for the clinical management of advanced Parkinson’s disease (PD) patients is the emergence of fluctuations in motor performance, which represents a significant source of disability during activities of daily living of the patients. There is a lack of objective measurement of treatment effects for in-clinic and at-home use that can provide an overview of the treatment response. The objective of this paper was to develop a method for objective quantification of advanced PD motor symptoms related to off episodes and peak dose dyskinesia, using spiral data gathered by a touch screen telemetry device. More specifically, the aim was to objectively characterize motor symptoms (bradykinesia and dyskinesia), to help in automating the process of visual interpretation of movement anomalies in spirals as rated by movement disorder specialists. Digitized upper limb movement data of 65 advanced PD patients and 10 healthy (HE) subjects were recorded as they performed spiral drawing tasks on a touch screen device in their home environment settings. Several spatiotemporal features were extracted from the time series and used as inputs to machine learning methods. The methods were validated against ratings on animated spirals scored by four movement disorder specialists who visually assessed a set of kinematic features and the motor symptom. The ability of the method to discriminate between PD patients and HE subjects and the test-retest reliability of the computed scores were also evaluated. Computed scores correlated well with mean visual ratings of individual kinematic features. The best performing classifier (Multilayer Perceptron) classified the motor symptom (bradykinesia or dyskinesia) with an accuracy of 84% and area under the receiver operating characteristics curve of 0.86 in relation to visual classifications of the raters. In addition, the method provided high discriminating power when distinguishing between PD patients and HE subjects as well as had good test-retest reliability. This study demonstrated the potential of using digital spiral analysis for objective quantification of PD-specific and/or treatment-induced motor symptoms.
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Ojo OO, Fernandez HH. Levodopa/carbidopa intestinal gel: an effective formulation for the management of advanced Parkinson's disease. FUTURE NEUROLOGY 2015. [DOI: 10.2217/fnl.15.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
SUMMARY With disease progression, almost all Parkinson's disease (PD) patients eventually experience motor fluctuations, often posing a significant challenge for patients and caregivers. Majority of these patients end up with complex medication regimens resulting in increased incidence of adverse effects and a poorer quality of life. Treatment options for advanced PD remain limited; thus, providing the optimal treatment for this growing subpopulation of patients continues to be the focus of many drug development efforts. While deep brain stimulation is considered the most significant therapeutic advancement for advanced PD, it remains an expensive and invasive procedure, with its own risks and complications, which limits global applicability to a wider PD population. Levodopa/carbidopa intestinal gel is one option that may offer a therapeutic benefit as significant as that of deep brain stimulation, and to a broader spectrum of PD patients. This article reviews the pharmacological properties, efficacy, safety and tolerability of levodopa/carbidopa intestinal gel in PD.
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Affiliation(s)
- Oluwadamilola O Ojo
- Center for Neurological Restoration, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
- Neurology Unit, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Hubert H Fernandez
- Center for Neurological Restoration, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
- Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA
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Martinez-Martin P, Rodriguez-Blazquez C, Forjaz MJ, Kurtis MM. Impact of Pharmacotherapy on Quality of Life in Patients with Parkinson's Disease. CNS Drugs 2015; 29:397-413. [PMID: 25968563 DOI: 10.1007/s40263-015-0247-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Quality of life (QoL) is a patient-reported outcome frequently included in Parkinson's disease (PD) clinical trials as a secondary or tertiary endpoint. However, QoL is an important variable that reflects the impact of disease and treatment from the patients' perspective. In a chronic, neurodegenerative disease such as PD, with a wide range of complex symptoms, QoL provides valuable and comprehensive information on the patients' health status. This narrative review aims to evaluate the effect of specific PD treatments currently in use on patients' QoL measured with the Parkinson's Disease Questionnaire, 39-item (PDQ-39) or 8-item (PDQ-8) version. A quantification of this effect is provided by calculation of the relative change and effect size. These two parameters allow an intuitive standardized approach to the importance of change based on its magnitude. Some high-quality studies (Level I) were found for levodopa (immediate- or extended-release formulations), levodopa with added-on catechol-O-methyltransferase (COMT) inhibitors, levodopa/carbidopa gel for intestinal infusion, some dopamine agonists (ropinirole, cabergoline, pergolide), and the monoamine oxidase B (MAO-B) inhibitor safinamide. As a whole, these studies found a beneficial effect of variable magnitude, weak to moderate, on patients' QoL. Studies with a lower level of evidence or not providing enough data to estimate relative change and effect size, including those for the apomorphine subcutaneous pump, also reported improvement of QoL, but the evidence was insufficient to confirm the effect. More high-quality studies focused on QoL are needed to determine the real impact of PD drug treatments for this important outcome.
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Affiliation(s)
- Pablo Martinez-Martin
- National Center of Epidemiology, Carlos III Institute of Health and CIBERNED, C/ Monforte de Lemos 5, 28029, Madrid, Spain.
| | - Carmen Rodriguez-Blazquez
- National Center of Epidemiology, Carlos III Institute of Health and CIBERNED, C/ Monforte de Lemos 5, 28029, Madrid, Spain
| | - Maria João Forjaz
- National School of Public Health, Carlos III Institute of Health and REDISSEC, Madrid, Spain
| | - Monica M Kurtis
- Movement Disorders Unit, Department of Neurology, Hospital Ruber Internacional, Madrid, Spain
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Global long-term study on motor and non-motor symptoms and safety of levodopa-carbidopa intestinal gel in routine care of advanced Parkinson's disease patients; 12-month interim outcomes. Parkinsonism Relat Disord 2015; 21:231-5. [DOI: 10.1016/j.parkreldis.2014.12.012] [Citation(s) in RCA: 106] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Revised: 11/11/2014] [Accepted: 12/14/2014] [Indexed: 11/20/2022]
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Sadikov A, Žabkar J, Možina M, Groznik V, Nyholm D, Memedi M. Feasibility of Spirography Features for Objective Assessment of Motor Symptoms in Parkinson’s Disease. Artif Intell Med 2015. [DOI: 10.1007/978-3-319-19551-3_35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Tarazi FI, Sahli ZT, Wolny M, Mousa SA. Emerging therapies for Parkinson's disease: from bench to bedside. Pharmacol Ther 2014; 144:123-33. [PMID: 24854598 DOI: 10.1016/j.pharmthera.2014.05.010] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Accepted: 05/01/2014] [Indexed: 02/08/2023]
Abstract
The prevalence of Parkinson's disease (PD) increases with age and is projected to increase in parallel to the rising average age of the population. The disease can have significant health-related, social, and financial implications not only for the patient and the caregiver, but for the health care system as well. While the neuropathology of this neurodegenerative disorder is fairly well understood, its etiology remains a mystery, making it difficult to target therapy. The currently available drugs for treatment provide only symptomatic relief and do not control or prevent disease progression, and as a result patient compliance and satisfaction are low. Several emerging pharmacotherapies for PD are in different stages of clinical development. These therapies include adenosine A2A receptor antagonists, glutamate receptor antagonists, monoamine oxidase inhibitors, anti-apoptotic agents, and antioxidants such as coenzyme Q10, N-acetyl cysteine, and edaravone. Other emerging non-pharmacotherapies include viral vector gene therapy, microRNAs, transglutaminases, RTP801, stem cells and glial derived neurotrophic factor (GDNF). In addition, surgical procedures including deep brain stimulation, pallidotomy, thalamotomy and gamma knife surgery have emerged as alternative interventions for advanced PD patients who have completely utilized standard treatments and still suffer from persistent motor fluctuations. While several of these therapies hold much promise in delaying the onset of the disease and slowing its progression, more pharmacotherapies and surgical interventions need to be investigated in different stages of PD. It is hoped that these emerging therapies and surgical procedures will strengthen our clinical armamentarium for improved treatment of PD.
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Affiliation(s)
- F I Tarazi
- Department of Psychiatry and Neuroscience Program, Harvard Medical School, McLean Hospital, Belmont, MA 02478, USA.
| | - Z T Sahli
- Department of Psychiatry and Neuroscience Program, Harvard Medical School, McLean Hospital, Belmont, MA 02478, USA; School of Medicine, American University of Beirut, Beirut, Lebanon
| | - M Wolny
- The Pharmaceutical Research Institute at Albany College of Pharmacy and Health Sciences, Rensselaer, NY 12144, USA
| | - S A Mousa
- The Pharmaceutical Research Institute at Albany College of Pharmacy and Health Sciences, Rensselaer, NY 12144, USA
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Jost WH. Unwanted effects and interaction of intrajejunal levodopa/carbidopa administration. Expert Opin Drug Saf 2014; 13:447-58. [PMID: 24611456 DOI: 10.1517/14740338.2014.896336] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Levodopa is the most effective treatment for Parkinson's disease. After a number of years on treatment, fluctuations and dyskinesias may develop. Hence, invasive treatment measures are often needed (escalation therapy). AREAS COVERED Twenty years ago, a levodopa/carbidopa intestinal gel (LCIG) that can be infused directly into the jejunum was developed. This provides for continuous dopaminergic stimulation. For the past 10 years, LCIG has been licensed in some countries and its marketing approval is pending in the USA. It is endowed with very good efficacy, and in studies, it has proven to be superior to oral drug treatment. Continuous dopaminergic stimulation is also assured, and fluctuations and dyskinesias are significantly reduced. However, this technique involves an invasive procedure with percutaneous endoscopic gastrostomy and attendant surgical and postsurgical complications. Besides, there are problems related to the pump and tube. Vitamin deficiency and polyneuropathies are other drawbacks. EXPERT OPINION LCIG is a beneficial and very useful treatment option as escalation therapy for Parkinson's disease. While the side effects are not insignificant, they are justifiable in view of the severity of the disease. Attention must be paid, in particular, to malabsorption, with monitoring at baseline and in the course of treatment.
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Affiliation(s)
- Wolfgang H Jost
- University of Freiburg, Parkinson-Klinik Wolfach , Kreuzbergstr. 12-24, D-77709 Wolfach , Germany +0049 7834/ 971 111 ; +0049 7834/ 971 340 ;
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Cannas A, Solla P, Marrosu MG, Marrosu F. Dopamine dysregulation syndrome in Parkinson's disease patients on duodenal levodopa infusion. Mov Disord 2014; 28:840-1. [PMID: 23801562 DOI: 10.1002/mds.25508] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Revised: 03/29/2013] [Accepted: 04/08/2013] [Indexed: 11/09/2022] Open
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Merola A, Zibetti M, Rizzone MG, Troiano M, Artusi CA, Angrisano S, Cocito D, Lopiano L. Prospective assessment of peripheral neuropathy in Duodopa-treated parkinsonian patients. Acta Neurol Scand 2014; 129:e1-5. [PMID: 23834498 DOI: 10.1111/ane.12164] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/04/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND Although peripheral neuropathies (PN) have been described in patients with Parkinson's disease (PD) treated with oral dopaminergic therapies, anecdotal reports of subacute severe PN have been reported during treatment with enteral levodopa/carbidopa infusion (Duodopa). AIM OF THE STUDY We prospectively assessed clinical and electrophysiological data of 15 consecutive patients with PD treated with Duodopa for a mean follow-up of 9 months. METHODS Nerve conduction studies and a clinical evaluation with a standardized battery of peripheral neuropathy scales were performed at baseline and after a mean follow-up of 9 months. RESULTS At baseline, mild signs of PN were observed in three subjects, and vitamin B12 serum levels were found to correlate with the amplitude of sural sensory action potentials. Follow-up data were available for 10/15 subjects: one patient developed a subacute sensory-motor PN and three subjects with pre-existing PN showed a moderate worsening of electrophysiological and clinical features. Subclinical electrophysiological alterations of peripheral nerves were observed in two subjects. No significant changes were observed in vitamin B12, folate, homocysteine and methylmalonic acid levels. CONCLUSIONS In this consecutive series of patients treated with Duodopa, we observed one subacute sensory-motor PN and few length-dependent alterations of peripheral nerves, similar to those described during oral levodopa treatment.
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Affiliation(s)
- A. Merola
- Department of Neuroscience; University of Turin; Torino Italy
| | - M. Zibetti
- Department of Neuroscience; University of Turin; Torino Italy
| | - M. G. Rizzone
- Department of Neuroscience; University of Turin; Torino Italy
| | - M. Troiano
- Department of Neuroscience; University of Turin; Torino Italy
| | - C. A. Artusi
- Department of Neuroscience; University of Turin; Torino Italy
| | - S. Angrisano
- Department of Neuroscience; University of Turin; Torino Italy
| | - D. Cocito
- Department of Neuroscience; University of Turin; Torino Italy
| | - L. Lopiano
- Department of Neuroscience; University of Turin; Torino Italy
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Abstract
Development of motor and non-motor complications during the course of Parkinson's disease (PD) is a major challenge for therapeutic management. At advanced disease stages, patients frequently fluctuate between PD symptoms-such as bradykinesia-and dyskinesias, in response to fluctuations in drug concentrations. Continuous subcutaneous infusion of the dopamine agonist apomorphine or intestinal infusion of levodopa reduce such fluctuations in both pharmacokinetics and motor function. This is the basis for the concept of continuous drug delivery in PD, and the more theoretical concept of continuous dopaminergic stimulation. These expressions are sometimes used to describe a treatment that is more continuous in its pharmacokinetic profile or that produces more sustained effects, compared with immediate-release levodopa, i.e. not only pump treatments. For example, sustained-release formulations of levodopa or dopamine agonists, transdermal delivery of rotigotine, and addition of catechol-O-methyltransferase inhibitors or monoamine oxidase-B inhibitors have been developed with the aim to provide more continuous drug concentrations, sustained benefits and minimized side effects. Progress has been made, but there are still knowledge gaps regarding how these treatment alternatives can be optimally used. New treatments are currently being developed to provide the continuous drug delivery that is known to successfully alleviate motor and non-motor complications. Hopefully, although not yet proven, these new methods may also prevent or postpone some of the late-stage complications.
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Affiliation(s)
- Marina Senek
- Department of Neuroscience, Neurology, Uppsala University, SE-75185, Uppsala, Sweden
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Pickut BA, van der Linden C, Dethy S, Van De Maele H, de Beyl DZ. Intestinal levodopa infusion: the Belgian experience. Neurol Sci 2013; 35:861-6. [PMID: 24379105 DOI: 10.1007/s10072-013-1612-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Accepted: 12/12/2013] [Indexed: 10/25/2022]
Abstract
Data concerning efficacy, safety, and patient satisfaction of levodopa/carbidopa intestinal gel (LCIG, Duodopa, AbbVie, Wavre, Belgium) infusion in routine clinical practice were needed to maintain reimbursement of the drug in Belgium. Patients with advanced Parkinson's disease in 27 neurology centers across Belgium were included. Of 100 patients who underwent naso-intestinal (NI) evaluation with LCIG, 67 received permanent treatment with LCIG via percutaneous endoscopic gastrostomy and jejunal tube (PEG/J). Efficacy was evaluated at baseline (on levodopa) and during a follow-up (FU) visit (on LCIG) using the Unified Parkinson's Disease Rating Scale (UPDRS) IV. Patient appraisal of the Duodopa system was evaluated using a visual analog scale for therapy compliance, user-friendliness, and global appreciation. Safety was assessed by reporting suspected adverse drug reactions (ADRs) and medical device-related complaints. FU evaluations were conducted in 37 patients. Significant improvement at FU was observed for motor complications (UPDRS IV) as the mean change from baseline to FU was -6.3 (95 % CI -8.1 to -4.5). Patient appraisal showed high scores for hospital delivery, user-friendliness, and patient global appreciation, as well as family appreciation of the system on daily life. Few ADRs and system malfunctions were reported, with no unexpected ADRs. In conclusion, the symptoms and impact of Parkinsonism improved markedly when LCIG PEG/J was initiated.
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Affiliation(s)
- Barbara Anne Pickut
- Department of Neurology, Antwerp University Hospital, Ziekenhuis Netwerk Antwerpen, Wilrijkstraat 10, 2650, Edegem, Antwerp, Belgium,
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Memedi M, Khan T, Grenholm P, Nyholm D, Westin J. Automatic and objective assessment of alternating tapping performance in Parkinson's disease. SENSORS (BASEL, SWITZERLAND) 2013; 13:16965-84. [PMID: 24351667 PMCID: PMC3892880 DOI: 10.3390/s131216965] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Revised: 11/21/2013] [Accepted: 12/05/2013] [Indexed: 11/16/2022]
Abstract
This paper presents the development and evaluation of a method for enabling quantitative and automatic scoring of alternating tapping performance of patients with Parkinson's disease (PD). Ten healthy elderly subjects and 95 patients in different clinical stages of PD have utilized a touch-pad handheld computer to perform alternate tapping tests in their home environments. First, a neurologist used a web-based system to visually assess impairments in four tapping dimensions ('speed', 'accuracy', 'fatigue' and 'arrhythmia') and a global tapping severity (GTS). Second, tapping signals were processed with time series analysis and statistical methods to derive 24 quantitative parameters. Third, principal component analysis was used to reduce the dimensions of these parameters and to obtain scores for the four dimensions. Finally, a logistic regression classifier was trained using a 10-fold stratified cross-validation to map the reduced parameters to the corresponding visually assessed GTS scores. Results showed that the computed scores correlated well to visually assessed scores and were significantly different across Unified Parkinson's Disease Rating Scale scores of upper limb motor performance. In addition, they had good internal consistency, had good ability to discriminate between healthy elderly and patients in different disease stages, had good sensitivity to treatment interventions and could reflect the natural disease progression over time. In conclusion, the automatic method can be useful to objectively assess the tapping performance of PD patients and can be included in telemedicine tools for remote monitoring of tapping.
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Affiliation(s)
- Mevludin Memedi
- School of Technology and Business Studies, Computer Engineering, Dalarna University, Falun SE-791 88, Sweden; E-Mails: (T.K.); (J.W.)
- School of Science and Technology, Örebro University, Örebro SE-701 82, Sweden
| | - Taha Khan
- School of Technology and Business Studies, Computer Engineering, Dalarna University, Falun SE-791 88, Sweden; E-Mails: (T.K.); (J.W.)
- School of Innovation, Design and Technology, Mälardalen University, Västerås SE-721 23, Sweden
| | - Peter Grenholm
- Department of Neuroscience, Neurology, Uppsala University, Uppsala SE-751 85, Sweden; E-Mails: (P.G.); (D.N.)
| | - Dag Nyholm
- Department of Neuroscience, Neurology, Uppsala University, Uppsala SE-751 85, Sweden; E-Mails: (P.G.); (D.N.)
| | - Jerker Westin
- School of Technology and Business Studies, Computer Engineering, Dalarna University, Falun SE-791 88, Sweden; E-Mails: (T.K.); (J.W.)
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Hu XW, Qin SM, Li D, Hu LF, Liu CF. Elevated homocysteine levels in levodopa-treated idiopathic Parkinson's disease: a meta-analysis. Acta Neurol Scand 2013; 128:73-82. [PMID: 23432663 DOI: 10.1111/ane.12106] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2013] [Indexed: 12/14/2022]
Abstract
To assess the association between the elevation of plasma homocysteine (Hcy) level and long-term levodopa (L-dopa) therapy in idiopathic Parkinson's disease (PD). We performed a systematic literature review to recruit original studies published up to May 14, 2012. Studies enrolled should be controlled, with specific information of long-term L-dopa application and plasma Hcy in patients with PD. Effects were summarized using standardized mean differences (SMDs) or weighted mean differences (WMDs). Our search enrolled 22 eligible studies. Plasma Hcy levels were significantly higher in L-dopa-treated patients than those in healthy controls [SMD 0.97; 95% confidence interval (CI) 0.80-1.14, P < 0.001], L-dopa-naïve patients with PD (SMD 0.99; 95% CI 0.54-1.44, P < 0.001), and untreated patients (SMD 0.52; 95% CI 0.18-0.86, P < 0.01). However, its levels in untreated patients with PD were not significantly higher than in healthy controls (SMD 0.24; 95% CI -0.03 to 0.51, P > 0.05). Patients with PD treated with L-dopa plus catechol-O-methyltransferase inhibitor (COMT-I) showed lower plasma Hcy concentrations compared with L-dopa-treated patients (WMD 4.62; 95% CI 2.89-6.35, P < 0.001). L-dopa treatment is associated with the increase in plasma Hcy level in patients with PD. COMT-I may attenuate L-dopa-induced elevation of Hcy level.
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Affiliation(s)
- X-W Hu
- Department of Neurology, The Second Affiliated Hospital of Soochow University, Suzhou, China
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Memedi M, Westin J, Nyholm D. Spiral drawing during self-rated dyskinesia is more impaired than during self-rated Off. Parkinsonism Relat Disord 2013; 19:553-6. [PMID: 23402993 DOI: 10.1016/j.parkreldis.2013.01.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2012] [Revised: 11/21/2012] [Accepted: 01/24/2013] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The purpose of this study was to examine repeated measures of fine motor function in relation to self-assessed motor conditions in Parkinson's disease (PD). METHODS One-hundred PD patients, 65 with advanced PD and 35 patients with different disease stages have utilized a test battery in a telemedicine setting. On each test occasion, they initially self-assessed their motor condition (from 'very off' to 'very dyskinetic') and then performed a set of fine motor tests (tapping and spiral drawings). RESULTS The motor tests scores were found to be the best during self-rated On. Self-rated dyskinesias caused more impaired spiral drawing performance (mean = 9.8% worse, P < 0.001) but at the same time tapping speed was faster (mean = 5.0% increase, P < 0.001), compared to scores in self-rated Off. CONCLUSIONS The fine motor tests of the test battery capture different symptoms; the spiral impairment primarily relates to dyskinesias whereas the tapping speed captures the Off symptoms.
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Affiliation(s)
- Mevludin Memedi
- School of Technology and Business Studies, Computer Engineering, Dalarna University, Borlänge, Sweden
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