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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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Subarachnoid Hemorrhage in Patients with SARS-CoV-2 Infection: Protocol for A Scoping Review. Brain Sci 2022; 12:brainsci12101327. [PMID: 36291263 PMCID: PMC9599430 DOI: 10.3390/brainsci12101327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Revised: 09/22/2022] [Accepted: 09/28/2022] [Indexed: 11/29/2022] Open
Abstract
Subarachnoid hemorrhage (SAH) is a life-threatening condition associated with high mortality and substantial long-term morbidity. The SARS-CoV-2 virus is a new pathogen that causes a disease with variable clinical manifestations. Although the Coronavirus disease 2019 (COVID-19) is associated with hypercoagulopathy, patients may also present with cerebral hemorrhage, including SAH. The present paper reports a protocol for a scoping review that is aimed to provide a comprehensive report on existing literature by examining data on SAH associated with SARS-CoV-2 infection. Our objective is to evaluate the epidemiology, clinical, laboratory, and neuroimaging features of SAH in patients with COVID-19 and to explore the etiology and possible interventions in this pathology. Using appropriate search terms, we will search LitCOVID, the WHO database on COVID-19, and MedRxiv. The inclusion criteria are pre-defined. We will extract the data of eligible studies in standardized forms and will report the results in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). We will provide information for clinicians, healthcare providers, and public health specialists.
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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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