Effect of duodenal levodopa infusion on blood pressure and sweating

Abstract

Non-motor symptoms are a major contributor to quality of life in patients with advanced Parkinson's disease (PD). Duodenal levodopa infusion (DLI) has been shown to alleviate motor fluctuations, but data on its possible effect on non-motor symptoms are scarce. The aim of the study was to assess the effect of DLI on blood pressure (BP), sweating, and non-motor symptoms. We evaluated prospectively and open-label nine male patients with advanced PD (age 68.5±6.2years) treated with DLI because of daily motor fluctuations. Patients were evaluated using orthostatic test, sweating and skin temperature measurements, Unified Parkinson's Disease Rating Scale (UPDRS), Non-motor Symptom Scale (NMSS), and PDQ-39 before and after 2months of treatment. Orthostatic BP drop worsened after 1week of DLI compared with oral medication (24.1 vs 11.9mmHg, P=0.011) and remained significant after 2months of treatment. UPDRS motor scores improved significantly in 2months compared with baseline (25 vs 19, P<0.01). Sweating or skin temperatures did not change. Several domains in NMSS (sleep/fatigue, gastrointestinal symptoms, sweating) and PDQ-39 (mobility, bodily discomfort, communication) improved significantly. BP should be monitored during initiation of DLI because of the risk of orthostatic hypotension. Our results indicate that DLI improves both motor and non-motor symptoms in patients with advanced PD.