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Szász JA, Dulamea AO, Constantin VA, Mureşanu DF, Dumbravă LP, Tiu C, Jianu DC, Simu M, Ene A, Axelerad A, Falup-Pecurariu C, Lungu M, Danci AG, Sabau M, Strilciuc Ş, Popescu BO. Levodopa-Carbidopa-Entacapone Intestinal Gel in Advanced Parkinson Disease: A Multicenter Real-Life Experience. Am J Ther 2024; 31:e209-e218. [PMID: 38460175 DOI: 10.1097/mjt.0000000000001707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2024]
Abstract
BACKGROUND For Parkinson disease (PD) patients who have been diagnosed with advanced disease that can no longer be effectively controlled with optimized oral or transdermal medications, a range of device-aided therapies (DAT) are available, comprising either deep brain stimulation or infusion therapies providing continuous dopaminergic stimulation. Levodopa-entacapone-carbidopa intestinal gel (LECIG) infusion is the latest DAT for advanced PD (APD) that was approved in Romania in 2021. STUDY QUESTION What is the experience to date in real-world clinical practice in Romania regarding the efficacy and tolerability of LECIG in APD? STUDY DESIGN A retrospective evaluation of 74 APD patients treated with LECIG at 12 specialized APD centers in Romania. MEASURES AND OUTCOMES Demographic data and various clinical parameters were recorded, including Mini Mental State Evaluation score or Montreal Cognitive Assessment Test score. Levodopa-equivalent daily dose and the administered doses of levodopa and other PD medications were evaluated at baseline and after starting LECIG treatment. The efficacy of LECIG in reducing daily hours of off time, motor fluctuations, and dyskinesias were assessed. Any percutaneous endoscopic gastrojejunostomy system or device complications after starting LECIG treatment were noted. RESULTS At baseline, patients were taking oral levodopa for a mean of 5.3 times per day, with a high proportion also taking concomitant add-on therapies (dopamine agonists, 86%, monoamine oxidase type-B inhibitors, 53%; catechol-O-methyltransferase inhibitors, 64%). LECIG treatment significantly reduced daily off time versus baseline from 5.7 h/d to 1.7 hours per day ( P < 0.01). Duration and severity of dyskinesias was also significantly reduced versus baseline, and improvements were observed in Hoehn and Yahr Scale scores. LECIG treatment also allowed a significant reduction in the use of concomitant oral medications. CONCLUSIONS These findings suggest that LECIG treatment is an effective DAT option in APD that can simplify the treatment regimen.
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Affiliation(s)
- József Attila Szász
- Department of Neurology, "George Emil Palade" University of Medicine, Pharmacy, Science and Technology, Târgu Mureş, Romania
- Neurology Department, Emergency Clinical County Hospital, Targu Mures, Romania
| | - Adriana Octaviana Dulamea
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
- Department of Neurology, Fundeni Clinical Institute, Bucharest, Romania
| | | | - Dafin Fior Mureşanu
- Department of Neuroscience, "Iuliu Haţieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
- Neurology Department, Emergency Clinical County Hospital, Cluj-Napoca, Romania
| | - Lăcrămioara Perju Dumbravă
- Department of Neuroscience, "Iuliu Haţieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
- Neurology Department, Emergency Clinical County Hospital, Cluj-Napoca, Romania
| | - Cristina Tiu
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
- Neurology Department, Bucharest University Emergency Hospital, Bucharest, Romania
| | - Dragoş Cătălin Jianu
- Department of Neurology, "Victor Babeş" University of Medicine and Pharmacy, Timişoara, Romania
- Neurology Department, "Pius Brânzeu" Emergency Clinical County Hospital, Timişoara, Romania
| | - Mihaela Simu
- Department of Neurology, "Victor Babeş" University of Medicine and Pharmacy, Timişoara, Romania
- Neurology Department, "Pius Brânzeu" Emergency Clinical County Hospital, Timişoara, Romania
| | - Amalia Ene
- Neurology Department, Bucharest University Emergency Hospital, Bucharest, Romania
| | - Any Axelerad
- Department of Neurology, "Ovidius" University, Faculty of Medicine, Constanţa, Romania
- Neurology Department, Sfântul Andrei Emergency Clinical County Hospital, Constanţa, Romania
| | - Cristian Falup-Pecurariu
- Faculty of Medicine, Transilvania University, Braşov, Romania
- Neurology Department, Emergency Clinical County Hospital, Braşov, Romania
| | - Mihaela Lungu
- Neurology Department, Emergency Clinical Hospital Galati, Faculty of Medicine and Pharmacy, Dunărea de Jos University, Galati, Romania
| | - Adina Gabriela Danci
- Neurology Department, Cluj-Napoca Military Emergency Hospital, Cluj-Napoca, Romania
| | - Monica Sabau
- Department of Psycho-Neuroscience and Medical Recovery, University of Medicine and Pharmacy Oradea, Emergency Clinical Hospital Bihor, Romania; and
| | - Ştefan Strilciuc
- Department of Neuroscience, "Iuliu Haţieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Bogdan Ovidiu Popescu
- Department of Clinical Neurosciences, Colentina Clinical Hospital, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
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Szatmári S, Szász JA, Orbán-Kis K, Baróti B, Bataga S, Ciorba M, Nagy EE, Neagoe RM, Mihály I, Szász PZ, Kelemen K, Frigy A, Szilveszter M, Constantin VA. Levodopa-Entacapone-Carbidopa Intestinal Gel in the Treatment of Advanced Parkinson's Disease: A Single Center Real-World Experience. Pharmaceutics 2024; 16:453. [PMID: 38675114 PMCID: PMC11053778 DOI: 10.3390/pharmaceutics16040453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 03/17/2024] [Accepted: 03/21/2024] [Indexed: 04/28/2024] Open
Abstract
Levodopa-entacapone-carbidopa intestinal gel infusion is a relatively new treatment option for advanced Parkinson's disease. We aimed to describe and analyze the characteristics of de novo levodopa-entacapone-carbidopa intestinal gel therapy in 20 consecutive patients with advanced Parkinson's disease. We assessed the profile of motor complications by evaluating the following: motor fluctuations, dyskinesias, and the freezing phenomenon at baseline (before the testing period) and before discharge. The treatment significantly reduced the duration of daily hours spent in off time compared with baseline pre-treatment values from a mean of 4.8 ± 0.9 h/day to a mean of 1.4 ± 0.5 h per day (p < 0.001). The duration and severity of peak-dose dyskinesia were also significantly reduced compared with baseline values. Out of the 10 patients who reported freezing, 8 did not present this complication at the pre-discharge assessment. Significant improvements were observed in Hoehn and Yahr scale scores in both the on and off states. The levodopa-entacapone-carbidopa intestinal gel therapy was well tolerated during the follow-up period immediately after initiation. Despite a relatively severe stage of the disease, all patients experienced a significant improvement in motor fluctuations, dyskinesias, and the freezing phenomenon.
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Affiliation(s)
- Szabolcs Szatmári
- 2nd Clinic of Neurology, Târgu Mures County Emergency Clinical Hospital, 540136 Târgu Mureș, Romania; (S.S.); (V.A.C.)
- George Emil Palade University of Medicine, Pharmacy, Science and Technology of Târgu Mures, 540142 Târgu Mureș, Romania; (B.B.); (S.B.); (I.M.); (P.Z.S.); (A.F.)
| | - József Attila Szász
- 2nd Clinic of Neurology, Târgu Mures County Emergency Clinical Hospital, 540136 Târgu Mureș, Romania; (S.S.); (V.A.C.)
- George Emil Palade University of Medicine, Pharmacy, Science and Technology of Târgu Mures, 540142 Târgu Mureș, Romania; (B.B.); (S.B.); (I.M.); (P.Z.S.); (A.F.)
| | - Károly Orbán-Kis
- 2nd Clinic of Neurology, Târgu Mures County Emergency Clinical Hospital, 540136 Târgu Mureș, Romania; (S.S.); (V.A.C.)
- George Emil Palade University of Medicine, Pharmacy, Science and Technology of Târgu Mures, 540142 Târgu Mureș, Romania; (B.B.); (S.B.); (I.M.); (P.Z.S.); (A.F.)
| | - Beáta Baróti
- George Emil Palade University of Medicine, Pharmacy, Science and Technology of Târgu Mures, 540142 Târgu Mureș, Romania; (B.B.); (S.B.); (I.M.); (P.Z.S.); (A.F.)
- Clinic of Radiology, Târgu Mures County Emergency Clinical Hospital, 540136 Târgu Mureș, Romania
| | - Simona Bataga
- George Emil Palade University of Medicine, Pharmacy, Science and Technology of Târgu Mures, 540142 Târgu Mureș, Romania; (B.B.); (S.B.); (I.M.); (P.Z.S.); (A.F.)
- Department of Gastroenterology, Târgu Mures County Emergency Clinical Hospital, 540136 Târgu Mureș, Romania
| | - Marius Ciorba
- George Emil Palade University of Medicine, Pharmacy, Science and Technology of Târgu Mures, 540142 Târgu Mureș, Romania; (B.B.); (S.B.); (I.M.); (P.Z.S.); (A.F.)
- Department of Gastroenterology, Târgu Mures County Emergency Clinical Hospital, 540136 Târgu Mureș, Romania
| | - Előd Ernő Nagy
- George Emil Palade University of Medicine, Pharmacy, Science and Technology of Târgu Mures, 540142 Târgu Mureș, Romania; (B.B.); (S.B.); (I.M.); (P.Z.S.); (A.F.)
- Laboratory of Medical Analysis, Clinical County Hospital Mures, 540072 Târgu Mureș, Romania
| | - Radu Mircea Neagoe
- George Emil Palade University of Medicine, Pharmacy, Science and Technology of Târgu Mures, 540142 Târgu Mureș, Romania; (B.B.); (S.B.); (I.M.); (P.Z.S.); (A.F.)
- 2nd Clinic of Surgery, Târgu Mures County Emergency Clinical Hospital, 540136 Târgu Mureș, Romania
| | - István Mihály
- George Emil Palade University of Medicine, Pharmacy, Science and Technology of Târgu Mures, 540142 Târgu Mureș, Romania; (B.B.); (S.B.); (I.M.); (P.Z.S.); (A.F.)
- Department of Neurology, Emergency County Hospital, 530173 Miercurea-Ciuc, Romania
| | - Péter Zsombor Szász
- George Emil Palade University of Medicine, Pharmacy, Science and Technology of Târgu Mures, 540142 Târgu Mureș, Romania; (B.B.); (S.B.); (I.M.); (P.Z.S.); (A.F.)
| | - Krisztina Kelemen
- 2nd Clinic of Neurology, Târgu Mures County Emergency Clinical Hospital, 540136 Târgu Mureș, Romania; (S.S.); (V.A.C.)
- George Emil Palade University of Medicine, Pharmacy, Science and Technology of Târgu Mures, 540142 Târgu Mureș, Romania; (B.B.); (S.B.); (I.M.); (P.Z.S.); (A.F.)
| | - Attila Frigy
- George Emil Palade University of Medicine, Pharmacy, Science and Technology of Târgu Mures, 540142 Târgu Mureș, Romania; (B.B.); (S.B.); (I.M.); (P.Z.S.); (A.F.)
- Department of Internal Medicine IV, Clinical County Hospital Mures, 540072 Târgu Mureș, Romania
| | - Mónika Szilveszter
- George Emil Palade University of Medicine, Pharmacy, Science and Technology of Târgu Mures, 540142 Târgu Mureș, Romania; (B.B.); (S.B.); (I.M.); (P.Z.S.); (A.F.)
| | - Viorelia Adelina Constantin
- 2nd Clinic of Neurology, Târgu Mures County Emergency Clinical Hospital, 540136 Târgu Mureș, Romania; (S.S.); (V.A.C.)
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Szatmári S, Szász JA, Orbán-Kis K, Bataga S, Ciorba M, Nagy E, Neagoe R, Mihály I, Szász PZ, Kelemen K, Frigy A, Csipor-Fodor A, Constantin VA. Starting with 24-h levodopa carbidopa intestinal gel at initiation in a large cohort of advanced Parkinson's disease patients. Sci Rep 2024; 14:3676. [PMID: 38355970 PMCID: PMC10867013 DOI: 10.1038/s41598-024-54299-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 02/11/2024] [Indexed: 02/16/2024] Open
Abstract
Continuous intra-jejunal infusion of levodopa-carbidopa intestinal gel (LCIG) is a long-term proven and effective treatment in advanced Parkinson's Disease (APD). Efficacy and safety of 16-h administration of LCIG has already been established. Additional benefits of 24-h LCIG administration have been reported in several case series and small clinical studies. The aim of this retrospective study was to compare the characteristics of patients who needed 24-h LCIG from the beginning of the DAT (device-aided treatment) with those who remained with the standard 16-h LCIG treatment and to identify particular motives if any. We initiated LCIG in 150 patients out of which in case of 62 patients (41,3%) due to unsatisfactory initial clinical benefits continuous 24-h LCIG was deemed necessary. Despite the subjective complaints and more severe clinical condition, at baseline evaluation we found statistically significant differences between 16-h LCIG cohort and 24-h LCIG cohort only in case of incidence of freezing (47% vs 65%, p = 0.03) and sudden off (32% vs 48%, p = 0.04). Wake hours/daytime LCIG does not always sufficiently improve the patient's quality of life in some patients due to persistent nighttime troublesome symptoms. Instead of labeling the patient as a non-responder, it is worth trying the 24-h LCIG dosage in a carefully selected group of patients, as there is currently no consensus on reliable criteria that serve the decision in these patients.
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Affiliation(s)
- Szabolcs Szatmári
- 2nd Clinic of Neurology, Târgu Mures County Emergency Clinical Hospital, Târgu Mureș, Romania
- University of Medicine, Pharmacy, Science and Technology of Târgu Mures, George Emil Palade, Gh. Marinescu Street No 38, 540142, Târgu Mures, Romania
| | - József Attila Szász
- 2nd Clinic of Neurology, Târgu Mures County Emergency Clinical Hospital, Târgu Mureș, Romania
- University of Medicine, Pharmacy, Science and Technology of Târgu Mures, George Emil Palade, Gh. Marinescu Street No 38, 540142, Târgu Mures, Romania
| | - Károly Orbán-Kis
- 2nd Clinic of Neurology, Târgu Mures County Emergency Clinical Hospital, Târgu Mureș, Romania.
- University of Medicine, Pharmacy, Science and Technology of Târgu Mures, George Emil Palade, Gh. Marinescu Street No 38, 540142, Târgu Mures, Romania.
| | - Simona Bataga
- University of Medicine, Pharmacy, Science and Technology of Târgu Mures, George Emil Palade, Gh. Marinescu Street No 38, 540142, Târgu Mures, Romania
- Department of Gastroenterology, Târgu Mures County Emergency Clinical Hospital, Târgu Mures, Romania
| | - Marius Ciorba
- University of Medicine, Pharmacy, Science and Technology of Târgu Mures, George Emil Palade, Gh. Marinescu Street No 38, 540142, Târgu Mures, Romania
- Department of Gastroenterology, Târgu Mures County Emergency Clinical Hospital, Târgu Mures, Romania
| | - Előd Nagy
- University of Medicine, Pharmacy, Science and Technology of Târgu Mures, George Emil Palade, Gh. Marinescu Street No 38, 540142, Târgu Mures, Romania
- Laboratory of Medical Analysis, Clinical County Hospital Mures, Târgu Mures, Romania
| | - Radu Neagoe
- University of Medicine, Pharmacy, Science and Technology of Târgu Mures, George Emil Palade, Gh. Marinescu Street No 38, 540142, Târgu Mures, Romania
- 2nd Clinic of Surgery, Târgu Mures County Emergency Clinical Hospital, Târgu Mures, Romania
| | - István Mihály
- University of Medicine, Pharmacy, Science and Technology of Târgu Mures, George Emil Palade, Gh. Marinescu Street No 38, 540142, Târgu Mures, Romania
- Department of Neurology, Emergency County Hospital, Miercurea-Ciuc, Romania
| | - Péter Zsombor Szász
- University of Medicine, Pharmacy, Science and Technology of Târgu Mures, George Emil Palade, Gh. Marinescu Street No 38, 540142, Târgu Mures, Romania
| | - Krisztina Kelemen
- 2nd Clinic of Neurology, Târgu Mures County Emergency Clinical Hospital, Târgu Mureș, Romania
- University of Medicine, Pharmacy, Science and Technology of Târgu Mures, George Emil Palade, Gh. Marinescu Street No 38, 540142, Târgu Mures, Romania
| | - Attila Frigy
- University of Medicine, Pharmacy, Science and Technology of Târgu Mures, George Emil Palade, Gh. Marinescu Street No 38, 540142, Târgu Mures, Romania
- Department of Internal Medicine IV, Clinical County Hospital Mures, Târgu Mures, Romania
| | - Andrea Csipor-Fodor
- 2nd Clinic of Neurology, Târgu Mures County Emergency Clinical Hospital, Târgu Mureș, Romania
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Constantin VA, Szász JA, Dulamea AO, Valkovic P, Kulisevsky J. Impact of Infusion Therapies on Quality of Life in Advanced Parkinson's Disease. Neuropsychiatr Dis Treat 2023; 19:1959-1972. [PMID: 37727253 PMCID: PMC10506606 DOI: 10.2147/ndt.s422717] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 09/01/2023] [Indexed: 09/21/2023] Open
Abstract
A high burden of motor and non-motor parkinsonian symptoms is known to have a significant negative impact on the quality of life (QoL) of people with Parkinson's disease (PD). Effective control of these symptoms with therapies that enable patients to maintain a good QoL is therefore a key treatment goal in PD management. When symptom control can no longer be accomplished with oral or transdermal PD treatment regimens, device-aided therapies (DAT), namely levodopa and apomorphine infusion therapies, and deep brain stimulation, are valuable options to consider. DAT options may also help reduce pill burden and thereby improve compliance with treatment. Since PD therapy relies on symptomatic management, the efficacy and tolerability of any intervention is undoubtedly important, however the impact of different therapies on patient-related outcome measures, in particular health-related QoL, is also a critical consideration for those living with a chronic and disabling condition. This review discusses clinical evidence and ongoing research regarding the QoL benefits of levodopa and apomorphine infusion therapies from studies that have used validated QoL outcome measures. The data suggest that timing of these interventions is important to achieve optimal treatment effects, and that early initiation onto infusion therapies at the point when motor fluctuations emerge, and before patient QoL and functioning have significantly declined, may provide the best long-term outcomes. Healthcare professionals caring for people with PD should therefore discuss all available DAT options with them at an early stage in the course of their disease so they can make informed and timely choices that best suit them, their families and care network.
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Affiliation(s)
- Viorelia A Constantin
- Second Clinic of Neurology, Târgu Mures County Emergency Clinical Hospital, Târgu Mureș, Romania
| | - József A Szász
- Second Clinic of Neurology, Târgu Mures County Emergency Clinical Hospital, Târgu Mureș, Romania
- Department of Neurology, George Emil Palade University of Medicine, Pharmacy, Science and Technology, Târgu Mureș, Romania
| | - Adriana Octaviana Dulamea
- Neurology Clinic, Fundeni Clinical Institute, Bucharest, Romania
- University of Medicine and Pharmacy “Carol Davila” Bucharest, Bucharest, Romania
| | - Peter Valkovic
- Second Department of Neurology, Comenius University Faculty of Medicine and University Hospital Bratislava, Bratislava, Slovakia
| | - Jaime Kulisevsky
- Movement Disorders Unit at the Neurology Department of Sant Pau Hospital, Barcelona, Spain
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A Rare Case of Histopathologically Confirmed Creutzfeldt–Jakob Disease from Romania, Long Route to Diagnosis—Case Report and an Overview of the Romanian CJD Situation. J Clin Med 2022; 11:jcm11164803. [PMID: 36013055 PMCID: PMC9409679 DOI: 10.3390/jcm11164803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 08/05/2022] [Accepted: 08/11/2022] [Indexed: 11/23/2022] Open
Abstract
Creutzfeldt–Jacob disease is a progressive and ultimately fatal disease, representing one of the most common forms of prion diseases. It is a rare pathology presenting with various symptomatology, and the fact that a definite diagnosis can be obtained solely by neuropathological techniques makes it hard to recognize and diagnose. Here we present the clinical and neuropathological features of a 72-year-old woman, who originally presented in a county hospital, then, along with the disease progression, got transferred to a university center in Romania, where CJD-specific tests are rarely performed, and ultimately was diagnosed with the help of international collaboration. The purpose of this case report and review is to summarize the Romanian CJD situation until the present day, to place the Romanian CJD epidemiology in an Eastern European context, and to highlight the diagnostic options and possibilities for clinical practitioners. We would also like to draw attention to the need for a national surveillance system. By presenting the patient’s route in Romania from the first presentation to diagnosis, we would like to emphasize the importance of interdisciplinary and international collaboration, by which we managed to cross the regional diagnostic boundaries and create a possible diagnostic pathway for future cases.
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Szász JA, Constantin VA, Orbán-Kis K, Bancu LA, Bataga SM, Ciorba M, Nagy E, Neagoe MR, Mihály I, Szász RM, Kelemen K, Simu M, Szatmári S. Levodopa-Carbidopa Intestinal Gel in Advanced Parkinson's Disease: Observations and Dilemmas after 10 Years of Real-Life Experience. Pharmaceutics 2022; 14:1115. [PMID: 35745688 PMCID: PMC9231164 DOI: 10.3390/pharmaceutics14061115] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 05/19/2022] [Accepted: 05/20/2022] [Indexed: 12/04/2022] Open
Abstract
Advanced Parkinson's disease (APD) cannot be treated efficiently using the classical medications however, in recent decades invasive therapeutical methods were implemented and confirmed as effective. One of these methods makes it possible to continue the levodopa (LD) supplementation as a gel administered directly into the upper intestine. However, there are a number of unanswered questions regarding this method. Therefore, we retrospectively analyzed a 10-year period of selected patients that were treated with levodopa/carbidopa intestinal gel (LCIG). We included all APD patients with motor fluctuations and dyskinesia at presentation. LCIG treatment was started in 150 patients: on average these patients received LD for 10.6 ± 4.4 years with a frequency of 5.2 ± 1.0/day until the introduction of LCIG. The estimated and the real LCIG dose differed significantly (mean: 1309 ± 321 mg vs. 1877 ± 769 mg). The mean duration of LCIG administration was 19.8 ± 3.6 h, but in a number of 62 patients we had to administer it for 24 h, to maximize the therapeutic benefit. A carefully and individually adjusted LCIG treatment improves the quality of life of APD patients, but questions remain unresolved even after treating a large number of patients. It is important to share the ideas and observations based on the real-life experience related to the optimal timing, the appropriate dose and duration of administration of the LCIG.
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Affiliation(s)
- József Attila Szász
- 2nd Clinic of Neurology, Târgu Mureș County Emergency Clinical Hospital, 540136 Târgu Mureș, Romania; (J.A.S.); (V.A.C.); (K.K.); (S.S.)
- Department of Neurology, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, 540139 Târgu Mureș, Romania;
| | - Viorelia Adelina Constantin
- 2nd Clinic of Neurology, Târgu Mureș County Emergency Clinical Hospital, 540136 Târgu Mureș, Romania; (J.A.S.); (V.A.C.); (K.K.); (S.S.)
- Doctoral School, ”Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania
| | - Károly Orbán-Kis
- 2nd Clinic of Neurology, Târgu Mureș County Emergency Clinical Hospital, 540136 Târgu Mureș, Romania; (J.A.S.); (V.A.C.); (K.K.); (S.S.)
- Department of Physiology, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, 540139 Târgu Mureș, Romania;
| | - Ligia Ariana Bancu
- Department of Internal Medicine, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, 540139 Târgu Mureș, Romania;
- 1st Clinic of Internal Medicine, Târgu Mureș County Emergency Clinical Hospital, 540142 Târgu Mureș, Romania
| | - Simona Maria Bataga
- Department of Gastroenterology, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, 540139 Târgu Mureș, Romania; (S.M.B.); (M.C.)
- Department of Gastroenterology, Târgu Mureș County Emergency Clinical Hospital, 540142 Târgu Mureș, Romania
| | - Marius Ciorba
- Department of Gastroenterology, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, 540139 Târgu Mureș, Romania; (S.M.B.); (M.C.)
- Department of Gastroenterology, Târgu Mureș County Emergency Clinical Hospital, 540142 Târgu Mureș, Romania
| | - Előd Nagy
- Department of Biochemistry, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, 540139 Târgu Mureș, Romania;
- Laboratory of Medical Analysis, Clinical County Hospital Mures, 540142 Târgu Mureș, Romania
| | - Mircea Radu Neagoe
- Department of Surgery, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, 540139 Târgu Mureș, Romania;
- 2nd Clinic of Surgery, Târgu Mures County Emergency Clinical Hospital, 540136 Târgu Mures, Romania
| | - István Mihály
- Department of Physiology, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, 540139 Târgu Mureș, Romania;
- Department of Neurology, Emergency County Hospital Miercurea Ciuc, 530173 Miercurea Ciuc, Romania
| | - Róbert Máté Szász
- Department of Neurology, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, 540139 Târgu Mureș, Romania;
| | - Krisztina Kelemen
- 2nd Clinic of Neurology, Târgu Mureș County Emergency Clinical Hospital, 540136 Târgu Mureș, Romania; (J.A.S.); (V.A.C.); (K.K.); (S.S.)
- Department of Physiology, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, 540139 Târgu Mureș, Romania;
| | - Mihaela Simu
- Department of Neurology, ”Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania;
- ”Pius Branzeu” Emergency Clinical County Hospital, 300723 Timisoara, Romania
| | - Szabolcs Szatmári
- 2nd Clinic of Neurology, Târgu Mureș County Emergency Clinical Hospital, 540136 Târgu Mureș, Romania; (J.A.S.); (V.A.C.); (K.K.); (S.S.)
- Department of Neurology, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, 540139 Târgu Mureș, Romania;
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Advanced Parkinson's Disease Treatment Simplification and Long-Term Outcomes with Levodopa Carbidopa Intestinal Gel: COSMOS Romanian Subanalysis. Brain Sci 2021; 11:brainsci11121566. [PMID: 34942868 PMCID: PMC8699449 DOI: 10.3390/brainsci11121566] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 11/23/2021] [Accepted: 11/24/2021] [Indexed: 12/04/2022] Open
Abstract
The aim of the COmedication Study assessing Mono- and cOmbination therapy with levodopa-carbidopa inteStinal gel (COSMOS) was to assess the use of levodopa/carbidopa intestinal gel (LCIG) as monotherapy in patients with advanced Parkinson’s disease (APD) in routine clinical practice. COSMOS was an international observational study with one cross-sectional visit and retrospective data collection. In Romania, 95 adult patients with APD on LCIG treatment for at least 12 months were enrolled and stratified according to their LCIG therapy after 12 months: monotherapy (without any add-on PD medication), monotherapy with night PD medication and LCIG + add-on medication. Compared to the moment of LCIG initiation, the percentage of patients on monotherapy increased at three months after LCIG initiation and remained constant up to 12 months, when 30.5% of the patients were on LCIG monotherapy and 11.6% were on monotherapy with night medication. “Off” time and “On” time with dyskinesia decreased from LCIG initiation to patient visit in all groups. LCIG monotherapy with or without night medication may provide a simplified treatment option for selected APD patients, with long-term efficacy similar to that of LCIG plus add-on medication.
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Loh HW, Hong W, Ooi CP, Chakraborty S, Barua PD, Deo RC, Soar J, Palmer EE, Acharya UR. Application of Deep Learning Models for Automated Identification of Parkinson's Disease: A Review (2011-2021). SENSORS 2021; 21:s21217034. [PMID: 34770340 PMCID: PMC8587636 DOI: 10.3390/s21217034] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 10/07/2021] [Accepted: 10/19/2021] [Indexed: 12/18/2022]
Abstract
Parkinson’s disease (PD) is the second most common neurodegenerative disorder affecting over 6 million people globally. Although there are symptomatic treatments that can increase the survivability of the disease, there are no curative treatments. The prevalence of PD and disability-adjusted life years continue to increase steadily, leading to a growing burden on patients, their families, society and the economy. Dopaminergic medications can significantly slow down the progression of PD when applied during the early stages. However, these treatments often become less effective with the disease progression. Early diagnosis of PD is crucial for immediate interventions so that the patients can remain self-sufficient for the longest period of time possible. Unfortunately, diagnoses are often late, due to factors such as a global shortage of neurologists skilled in early PD diagnosis. Computer-aided diagnostic (CAD) tools, based on artificial intelligence methods, that can perform automated diagnosis of PD, are gaining attention from healthcare services. In this review, we have identified 63 studies published between January 2011 and July 2021, that proposed deep learning models for an automated diagnosis of PD, using various types of modalities like brain analysis (SPECT, PET, MRI and EEG), and motion symptoms (gait, handwriting, speech and EMG). From these studies, we identify the best performing deep learning model reported for each modality and highlight the current limitations that are hindering the adoption of such CAD tools in healthcare. Finally, we propose new directions to further the studies on deep learning in the automated detection of PD, in the hopes of improving the utility, applicability and impact of such tools to improve early detection of PD globally.
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Affiliation(s)
- Hui Wen Loh
- School of Science and Technology, Singapore University of Social Sciences, Singapore 599494, Singapore
| | - Wanrong Hong
- Cogninet Brain Team, Cogninet Australia, Sydney, NSW 2010, Australia
| | - Chui Ping Ooi
- School of Science and Technology, Singapore University of Social Sciences, Singapore 599494, Singapore
| | - Subrata Chakraborty
- Faculty of Engineering and Information Technology, University of Technology Sydney, Sydney, NSW 2007, Australia
| | - Prabal Datta Barua
- Cogninet Brain Team, Cogninet Australia, Sydney, NSW 2010, Australia
- Faculty of Engineering and Information Technology, University of Technology Sydney, Sydney, NSW 2007, Australia
- School of Business (Information Systems), Faculty of Business, Education, Law & Arts, University of Southern Queensland, Toowoomba, QLD 4350, Australia
| | - Ravinesh C Deo
- School of Sciences, University of Southern Queensland, Springfield, QLD 4300, Australia
| | - Jeffrey Soar
- School of Business (Information Systems), Faculty of Business, Education, Law & Arts, University of Southern Queensland, Toowoomba, QLD 4350, Australia
| | - Elizabeth E Palmer
- Centre of Clinical Genetics, Sydney Children's Hospitals Network, Randwick, NSW 2031, Australia
- School of Women's and Children's Health, University of New South Wales, Randwick, NSW 2031, Australia
| | - U Rajendra Acharya
- School of Science and Technology, Singapore University of Social Sciences, Singapore 599494, Singapore
- School of Business (Information Systems), Faculty of Business, Education, Law & Arts, University of Southern Queensland, Toowoomba, QLD 4350, Australia
- School of Engineering, Ngee Ann Polytechnic, Singapore 599489, Singapore
- Department of Bioinformatics and Medical Engineering, Asia University, Taichung 413, Taiwan
- Research Organization for Advanced Science and Technology (IROAST), Kumamoto University, Kumamoto 860-8555, Japan
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9
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Szász JA, Constantin VA, Orbán-Kis K, Bancu LA, Ciorba M, Mihály I, Nagy EE, Szász RM, Kelemen K, Simu MA, Szatmári S. Management Challenges of Severe, Complex Dyskinesia. Data from a Large Cohort of Patients Treated with Levodopa-Carbidopa Intestinal Gel for Advanced Parkinson's Disease. Brain Sci 2021; 11:826. [PMID: 34206596 PMCID: PMC8301838 DOI: 10.3390/brainsci11070826] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 06/12/2021] [Accepted: 06/18/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND In the advanced stages of Parkinson's disease (APD), complex forms of dyskinesia may severely impair the patient's quality of life. OBJECTIVE In the present study, we aimed to analyze the evolution under LCIG therapy of the most important motor fluctuations and complex disabling dyskinesias, including diphasic dyskinesia. METHODS In this retrospective study, we analyzed the characteristics of patients with APD who had at least 30 min of diphasic dyskinesia (DID) in 3 consecutive days, were considered responders and were treated with LCIG in our clinic. Patients were evaluated before and after PEG and at 6, 12 and 18 months, when the changes in the therapy were recorded, and they completed a 7-point Global Patient Impression of Improvement (PGI-I) scale. RESULTS Forty patients fulfilled the inclusion criteria-out of which, 34 performed all visits. There was a substantial difference between the calculated and real LCIG (1232 ± 337 mg vs. 1823 ± 728 mg). The motor fluctuations and most dyskinesias improved significantly after starting LCIG, but an increasing number of patients needed longer daily administrations of LCIG (24 instead of 16 h). CONCLUSIONS Patients with APD with complex dyskinesias must be tested in dedicated hospitals, and they need a special therapeutic approach. The properly adapted LCIG treatment regarding the dose and time of administration completed with well-selected add-on medication should offer improvement for patients who want to or can only choose this DAT vs. others.
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Affiliation(s)
- József Attila Szász
- 2nd Clinic of Neurology, Târgu Mureș County Emergency Clinical Hospital, 540136 Târgu Mureș, Romania; (J.A.S.); (V.A.C.); (I.M.); (K.K.); (S.S.)
- “George Emil Palade” University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, 540142 Târgu Mureș, Romania; (L.A.B.); (M.C.); (E.E.N.); (R.M.S.)
| | - Viorelia Adelina Constantin
- 2nd Clinic of Neurology, Târgu Mureș County Emergency Clinical Hospital, 540136 Târgu Mureș, Romania; (J.A.S.); (V.A.C.); (I.M.); (K.K.); (S.S.)
- Doctoral School, ”Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timișoara, Romania
| | - Károly Orbán-Kis
- 2nd Clinic of Neurology, Târgu Mureș County Emergency Clinical Hospital, 540136 Târgu Mureș, Romania; (J.A.S.); (V.A.C.); (I.M.); (K.K.); (S.S.)
- “George Emil Palade” University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, 540142 Târgu Mureș, Romania; (L.A.B.); (M.C.); (E.E.N.); (R.M.S.)
| | - Ligia Ariana Bancu
- “George Emil Palade” University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, 540142 Târgu Mureș, Romania; (L.A.B.); (M.C.); (E.E.N.); (R.M.S.)
- 1st Clinic of Internal Medicine, Târgu Mures County Emergency Clinical Hospital, 540142 Târgu Mureș, Romania
| | - Marius Ciorba
- “George Emil Palade” University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, 540142 Târgu Mureș, Romania; (L.A.B.); (M.C.); (E.E.N.); (R.M.S.)
- Department of Gastroenterology, Târgu Mures County Emergency Clinical Hospital, 540142 Târgu Mureș, Romania
| | - István Mihály
- 2nd Clinic of Neurology, Târgu Mureș County Emergency Clinical Hospital, 540136 Târgu Mureș, Romania; (J.A.S.); (V.A.C.); (I.M.); (K.K.); (S.S.)
- “George Emil Palade” University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, 540142 Târgu Mureș, Romania; (L.A.B.); (M.C.); (E.E.N.); (R.M.S.)
| | - Előd Ernő Nagy
- “George Emil Palade” University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, 540142 Târgu Mureș, Romania; (L.A.B.); (M.C.); (E.E.N.); (R.M.S.)
- Laboratory of Medical Analysis, Clinical County Hospital Mures, 540142 Târgu Mureș, Romania
| | - Róbert Máté Szász
- “George Emil Palade” University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, 540142 Târgu Mureș, Romania; (L.A.B.); (M.C.); (E.E.N.); (R.M.S.)
| | - Krisztina Kelemen
- 2nd Clinic of Neurology, Târgu Mureș County Emergency Clinical Hospital, 540136 Târgu Mureș, Romania; (J.A.S.); (V.A.C.); (I.M.); (K.K.); (S.S.)
- “George Emil Palade” University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, 540142 Târgu Mureș, Romania; (L.A.B.); (M.C.); (E.E.N.); (R.M.S.)
| | - Mihaela Adriana Simu
- Department of Neurology II, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timișoara, Romania;
- ”Pius Branzeu” Emergency Clinical County Hospital, 300723 Timișoara, Romania
| | - Szabolcs Szatmári
- 2nd Clinic of Neurology, Târgu Mureș County Emergency Clinical Hospital, 540136 Târgu Mureș, Romania; (J.A.S.); (V.A.C.); (I.M.); (K.K.); (S.S.)
- “George Emil Palade” University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, 540142 Târgu Mureș, Romania; (L.A.B.); (M.C.); (E.E.N.); (R.M.S.)
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10
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Rosca EC, Tudor R, Cornea A, Simu M. Parkinson's Disease in Romania: A Scoping Review. Brain Sci 2021; 11:709. [PMID: 34071802 PMCID: PMC8226866 DOI: 10.3390/brainsci11060709] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 05/16/2021] [Accepted: 05/25/2021] [Indexed: 12/12/2022] Open
Abstract
Parkinson's disease (PD) is a significant cause of disability, with a fast-growing prevalence. This review summarizes the epidemiological and clinical data, research on the diagnostic approaches and the interventions available in the Eastern European country of Romania. This scoping review follows the recommendations on the scoping review methodology by Joanna Briggs Institute. We searched four databases (up to 27 January 2021). The data of eligible studies were extracted in standardized forms. We identified 149 unique studies from 1133 records, with 11 epidemiological studies, 52 studies investigating clinical aspects of PD, 35 studies on diagnostic tools, and 51 intervention studies. A narrative synthesis is provided and placed in a historical context. Our review revealed a considerable increase in the Romanian research on PD in the latest 15 years, which largely follows international trends. However, we also identified several research gaps that provide useful information for policymakers, public health specialists, and clinicians.
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Affiliation(s)
- Elena Cecilia Rosca
- Department of Neurology, Victor Babes University of Medicine and Pharmacy of Timisoara, Eftimie Murgu Sq. No. 2, 300041 Timișoara, Romania; (R.T.); (A.C.); (M.S.)
- Department of Neurology, Clinical Emergency County Hospital Timisoara, Bd. Iosif Bulbuca No. 10, 300736 Timisoara, Romania
- Neuroscience Research Center Timisoara, Clinical Emergency County Hospital Timisoara, Bd. Iosif Bulbuca No. 10, 300736 Timisoara, Romania
| | - Raluca Tudor
- Department of Neurology, Victor Babes University of Medicine and Pharmacy of Timisoara, Eftimie Murgu Sq. No. 2, 300041 Timișoara, Romania; (R.T.); (A.C.); (M.S.)
- Department of Neurology, Clinical Emergency County Hospital Timisoara, Bd. Iosif Bulbuca No. 10, 300736 Timisoara, Romania
- Neuroscience Research Center Timisoara, Clinical Emergency County Hospital Timisoara, Bd. Iosif Bulbuca No. 10, 300736 Timisoara, Romania
| | - Amalia Cornea
- Department of Neurology, Victor Babes University of Medicine and Pharmacy of Timisoara, Eftimie Murgu Sq. No. 2, 300041 Timișoara, Romania; (R.T.); (A.C.); (M.S.)
- Department of Neurology, Clinical Emergency County Hospital Timisoara, Bd. Iosif Bulbuca No. 10, 300736 Timisoara, Romania
- Neuroscience Research Center Timisoara, Clinical Emergency County Hospital Timisoara, Bd. Iosif Bulbuca No. 10, 300736 Timisoara, Romania
| | - Mihaela Simu
- Department of Neurology, Victor Babes University of Medicine and Pharmacy of Timisoara, Eftimie Murgu Sq. No. 2, 300041 Timișoara, Romania; (R.T.); (A.C.); (M.S.)
- Department of Neurology, Clinical Emergency County Hospital Timisoara, Bd. Iosif Bulbuca No. 10, 300736 Timisoara, Romania
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11
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Szatmári S, Ajtay A, Oberfrank F, Dobi B, Bereczki D. The prevalence of psychiatric symptoms before the diagnosis of Parkinson's disease in a nationwide cohort: A comparison to patients with cerebral infarction. PLoS One 2020; 15:e0236728. [PMID: 32750069 PMCID: PMC7402492 DOI: 10.1371/journal.pone.0236728] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 07/11/2020] [Indexed: 11/23/2022] Open
Abstract
Objectives Psychiatric symptoms (PS) can be non-motor features in Parkinson’s disease (PD) which are common even in the prodromal, untreated phase of the disease. Some PS, especially depression and anxiety recently became known predictive markers for PD. Our objective was to explore retrospectively the prevalence of PS before the diagnosis of PD. Methods In the framework of the Hungarian Brain Research Program we created a database from medical and medication reports submitted for reimbursement purposes to the National Health Insurance Fund in Hungary, a country with 10 million inhabitants and a single payer health insurance system. We used record linkage to evaluate the prevalence of PS before the diagnosis of PD and compared that with patients with ischemic cerebrovascular lesion (ICL) in the period between 2004–2016 using ICD-10 codes of G20 for PD, I63-64 for ICL and F00-F99 for PS. We included only those patients who got their PD, ICL and psychiatric diagnosis at least twice. Results There were 79 795 patients with PD and 676 874 patients with ICL. Of the PD patients 16% whereas of those with ischemic cerebrovascular lesion 9.7% had a psychiatric diagnosis before the first appearance of PD or ICL (p<0.001) established in psychiatric care at least twice. The higher rate of PS in PD compared to ICL remained significant after controlling for age and gender in logistic regression analysis. The difference between PD and ICL was significant for Mood disorders (F30-F39), Organic, including symptomatic, mental disorders (F00-F09), Neurotic, stress-related and somatoform disorders (F40-F48) and Schizophrenia, schizotypal and delusional disorders (F20-F29) diagnosis categories (p<0.001, for all). Discussion The higher rate of psychiatric morbidity in the premotor phase of PD may reflect neurotransmitter changes in the early phase of PD.
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Affiliation(s)
- Szabolcs Szatmári
- János Szentágothai Doctoral School of Neurosciences, Semmelweis University, Budapest, Hungary
- Department of Neurology, Semmelweis University, Budapest, Hungary
- MTA-SE Neuroepidemiological Research Group, Budapest, Hungary
| | - András Ajtay
- Department of Neurology, Semmelweis University, Budapest, Hungary
- MTA-SE Neuroepidemiological Research Group, Budapest, Hungary
| | | | - Balázs Dobi
- MTA-SE Neuroepidemiological Research Group, Budapest, Hungary
- Department of Probability Theory and Statistics, Eötvös Loránd University, Budapest, Hungary
| | - Dániel Bereczki
- Department of Neurology, Semmelweis University, Budapest, Hungary
- MTA-SE Neuroepidemiological Research Group, Budapest, Hungary
- * E-mail:
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12
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Constantin VA, Szász JA, Orbán-Kis K, Rosca EC, Popovici M, Cornea A, Bancu LA, Ciorba M, Mihály I, Nagy E, Szatmári S, Simu M. Levodopa-Carbidopa Intestinal Gel Infusion Therapy Discontinuation: A Ten-Year Retrospective Analysis of 204 Treated Patients. Neuropsychiatr Dis Treat 2020; 16:1835-1844. [PMID: 32801718 PMCID: PMC7395851 DOI: 10.2147/ndt.s256988] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 06/25/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Parkinson's disease (PD) is the second most common progressive neurodegenerative disease. In the advanced stages, the continuous delivery of levodopa (LD) as levodopa-carbidopa intestinal gel (LCIG) has demonstrated significant improvement of motor and nonmotor complications and improvement of the patients' quality of life (QoL). Despite the growing global experience with this treatment, anumber of unsolved practical issues remain, and currently, the data on the reasons that can lead to the discontinuation of LCIG are scarce. OBJECTIVE In the present study, we aimed to analyze the causes that led to the discontinuation of LCIG therapy. METHODS In this retrospective study, after 10 years of experience with LCIG as a therapeutic option in advanced PD, we analyzed the data of all dropout cases among the 204 patients that initiated LCIG therapy in two Romanian centers. RESULTS Of the 204 patients enrolled, 43 patients dropped out. Disease duration until LCIG infusion was significantly longer (11.67±4.98 vs 9.44±3.44) and the overall clinical picture more sever (both regarding motor symptoms and cognitive decline) in dropout patients (compared to patients who continued treatment). The dropout patients also presented significant differences regarding the incidence of polyneuropathy (32.5% vs 11.18%). The main cause of discontinuation was death. CONCLUSION The causes of discontinuation from LCIG therapy in Romanian patients are similar to those from other centers; however, the rate of dropouts is somewhat lower. The clinician's experience in selecting and treating the patients in advanced stages of PD can increase therapeutic adherence. Also, the presence of a well-trained caregiver along with the availability of a proper aftercare system is mandatory for maintaining the long-term benefits of the therapy and the overall best outcome possible. Targeted prospective studies are needed to confirm whether a more severe stage of the disease and cognitive impairment at the time of initiation, respectively, the association of polyneuropathy can be considered as predictive factors for dropout.
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Affiliation(s)
- Viorelia Adelina Constantin
- 2nd Clinic of Neurology, Târgu Mureș County Emergency Clinical Hospital, Târgu Mureș, Romania
- Doctoral School, “Victor Babes” University of Medicine and Pharmacy Timisoara, Timisoara, Romania
| | - József Attila Szász
- 2nd Clinic of Neurology, Târgu Mureș County Emergency Clinical Hospital, Târgu Mureș, Romania
- Department of Neurology, “George Emil Palade” University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, Târgu Mureș, Romania
| | - Károly Orbán-Kis
- 2nd Clinic of Neurology, Târgu Mureș County Emergency Clinical Hospital, Târgu Mureș, Romania
- Department of Physiology, “George Emil Palade” University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, Târgu Mureș, Romania
| | - Elena Cecilia Rosca
- Department of Neurology, “Victor Babes” University of Medicine and Pharmacy Timisoara, Timisoara, Romania
- Department of Neurology, “Pius Branzeu” Emergency Clinical County Hospital, Timisoara, Romania
| | | | - Amalia Cornea
- Department of Neurology, “Victor Babes” University of Medicine and Pharmacy Timisoara, Timisoara, Romania
- Department of Neurology, “Pius Branzeu” Emergency Clinical County Hospital, Timisoara, Romania
| | - Ligia Ariana Bancu
- Department of Internal Medicine, “George Emil Palade” University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, Târgu Mureș, Romania
- 1 Clinic of Internal Medicine, Târgu Mureș County Emergency Clinical Hospital, Târgu Mureș, Romania
| | - Marius Ciorba
- Department of Internal Medicine, “George Emil Palade” University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, Târgu Mureș, Romania
- Department of Gastroenterology, Târgu Mureș County Emergency Clinical Hospital, Târgu Mureș, Romania
| | - István Mihály
- 2nd Clinic of Neurology, Târgu Mureș County Emergency Clinical Hospital, Târgu Mureș, Romania
- Department of Physiology, “George Emil Palade” University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, Târgu Mureș, Romania
| | - Előd Nagy
- Department of Biochemistry and Environmental Chemistry, “George Emil Palade” University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, Târgu Mureș, Romania
- Laboratory of Medical Analysis, Clinical County Hospital Mureș, Târgu Mureș, Romania
| | - Szabolcs Szatmári
- 2nd Clinic of Neurology, Târgu Mureș County Emergency Clinical Hospital, Târgu Mureș, Romania
- Department of Neurology, “George Emil Palade” University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, Târgu Mureș, Romania
| | - Mihaela Simu
- Department of Neurology, “Victor Babes” University of Medicine and Pharmacy Timisoara, Timisoara, Romania
- Department of Neurology, “Pius Branzeu” Emergency Clinical County Hospital, Timisoara, Romania
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Szász JA, Constantin VA, Orbán-Kis K, Rácz A, Bancu LA, Georgescu D, Szederjesi J, Mihály I, Fárr AM, Kelemen K, Vajda T, Szatmári S. Profile Of Patients With Advanced Parkinson's disease Suitable For Device-Aided Therapies: Restrospective Data Of A Large Cohort Of Romanian Patients. Neuropsychiatr Dis Treat 2019; 15:3187-3195. [PMID: 32009788 PMCID: PMC6859121 DOI: 10.2147/ndt.s230052] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 10/29/2019] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND There is insufficient data in the literature regarding the real-life, daily clinical practice evaluation of patients with advanced Parkinson's disease (APD). We are not sure what is the upper limit of dopaminergic medication, especially the levodopa (LD) dosage, and how it is influenced by access and suitability to the various add-on and device-aided therapies (DAT). OBJECTIVE This retrospective study explored the profile of APD patients that were considered and systematically evaluated regarding the suitability for DAT. METHODS We analyzed the data from 311 consecutive patients with APD hospitalized between 2011 and 2017 that 1) described at least 2 hrs/day off periods divided into at least two instances/day (except early morning akinesia), 2) were in stage 3 or above on the Hoehn and Yahr scale, 3) were with or without dyskinesia, and 4) received at least four levodopa doses/day combined with adjuvant therapy. RESULTS Of the 311 patients enrolled initially, 286 patients showed up for the second visit, of which in 125 cases we assessed that DAT would be necessary. Finally, 107 patients were tested in our clinic to confirm the efficacy of LCIG. Patients selected for DAT had significantly longer off periods, more frequent dyskinesia, early morning akinesia, and freezing despite having significantly higher LD doses than those with an improved conservative therapy. CONCLUSION Patients with APD can have a variety of symptoms, and because symptoms and therapeutical efficacy can be manifested in many different combinations, it is not possible to decide using a single, rigid set of criteria which APD patient is eligible for DAT. Nevertheless, treating physicians should refer APD patients to a specialized movement disorder center when patients with an average daily dose of LD of at least 750-1000 mg and maximal complementary therapies present daily motor complications that significantly reduce the quality of life.
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Affiliation(s)
- József Attila Szász
- University of Medicine and Pharmacy of Târgu Mures, Târgu Mureş, Romania.,2nd Clinic of Neurology, Târgu Mures County Emergency Clinical Hospital, Târgu Mures, Romania
| | - Viorelia Adelina Constantin
- 2nd Clinic of Neurology, Târgu Mures County Emergency Clinical Hospital, Târgu Mures, Romania.,Doctoral School, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
| | - Károly Orbán-Kis
- University of Medicine and Pharmacy of Târgu Mures, Târgu Mureş, Romania.,2nd Clinic of Neurology, Târgu Mures County Emergency Clinical Hospital, Târgu Mures, Romania
| | - Attila Rácz
- 2nd Clinic of Psychiatry, Târgu Mures County Emergency Clinical Hospital, Târgu Mures, Romania
| | - Ligia Ariana Bancu
- University of Medicine and Pharmacy of Târgu Mures, Târgu Mureş, Romania.,1st Clinic of Internal Medicine, Târgu Mures County Emergency Clinical Hospital, Târgu Mures, Romania
| | - Dan Georgescu
- University of Medicine and Pharmacy of Târgu Mures, Târgu Mureş, Romania.,Department of Gastroenterology, Târgu Mures County Emergency Clinical Hospital, Târgu Mures, Romania
| | - János Szederjesi
- University of Medicine and Pharmacy of Târgu Mures, Târgu Mureş, Romania.,Department of Anesthesiology and Intensive Care, Târgu Mures County Emergency Clinical Hospital, Târgu Mures, Romania
| | - István Mihály
- University of Medicine and Pharmacy of Târgu Mures, Târgu Mureş, Romania.,2nd Clinic of Neurology, Târgu Mures County Emergency Clinical Hospital, Târgu Mures, Romania
| | - Ana-Mária Fárr
- University of Medicine and Pharmacy of Târgu Mures, Târgu Mureş, Romania
| | - Krisztina Kelemen
- University of Medicine and Pharmacy of Târgu Mures, Târgu Mureş, Romania.,2nd Clinic of Neurology, Târgu Mures County Emergency Clinical Hospital, Târgu Mures, Romania
| | - Tamás Vajda
- Department of Computer Science, Faculty of Technical and Human Sciences, Sapientia Hungarian University of Transylvania, Târgu Mureș, Romania
| | - Szabolcs Szatmári
- University of Medicine and Pharmacy of Târgu Mures, Târgu Mureş, Romania.,2nd Clinic of Neurology, Târgu Mures County Emergency Clinical Hospital, Târgu Mures, Romania
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