Long-term 24-hour duodenal infusion of levodopa: Outcome and dose requirements

Abstract

Short-term IV 24-hour levodopa infusion has been shown to improve motor variability and dyskinesias in patients with Parkinson disease (PD) with motor fluctuations.1 Longer-term around-the-clock enteral infusion of levodopa (n = 1) showed declining motor performance although the infusion rate was rapidly increased.2 It has been proposed that tolerance develops as a result of long continuous infusions of levodopa and dopamine agonists.3 Nighttime-only levodopa infusion has been reported in one case with immediate improvement of nocturnal akinesia.4 Duodenal/jejunal levodopa/carbidopa infusion (Duodopa) has evolved into a treatment alternative in patients with advanced PD.5 It is recommended for daytime use partly because of convenience for the patient and partly because of fear of tolerance development. Because nighttime disability and sleep disturbance are common problems for patients with advanced PD,6 oral dopaminergic medication is sometimes used during nighttime to improve sleep. We report retrospective data on five cases with continuous …