23 Peripheral neuropathy in Parkinson’s disease patients treated with Duodopa: A 9 months clinical and electrophysiological follow-up study

Abstract

Background Sensory-axonal peripheral neuropathies (PN) have been described in Parkinson’s disease (PD) patients treated with oral dopaminergic therapies. Moreover, few cases of subacute severe PN were reported in parkinsonian patients treated with enteral levodopa/carbidopa gel infusion (Duodopa), suggesting that this particular mean of levodopa administration could be associated with a higher risk of developing PN. In this study we report the follow-up clinical and electrophysiological data of 15 consecutive PD patients treated with Duodopa infusion between July 2010 and September 2011. Methods Patients were evaluated by means of a clinical and electrophysiological assessment, both before the placement of Duodopa intestinal tube and after a mean follow-up duration of 9 months. Results A higher rate of electrophysiological alterations in peripheral nerves was found at follow-up, comparing to the baseline evaluation. Two main patterns of PN were observed; the first one was characterized by a severe sensory-motor PN with a subacute onset (1 patient), while the second one was characterized by a mild sensory dominant axonal impairment (4 patients). Conclusions Two different patterns of PN were observed in PD patients treated with Duodopa therapy: a more aggressive subacute sensory-motor PN, which may be potentially triggered by immune-mediated responses or by vitamin adsorption deficiency, and a milder sensory axonal length-dependent PN, which share many similarities with the typical electrophysiological pattern described in PD patients treated with oral dopaminergic therapies. Taken together these data suggest that serial electrophysiological assessment may be advisable in PD patients under Duodopa treatment.