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.
Highlights
Parkinson’s disease (PD) is the second-most frequent, progressively worsening neurodegenerative disorder
During the 6-year period covered by this analysis, we enrolled all advanced stages of Parkinson’s disease (APD) patients still responding to LD who (i) reported at least 2 h/day of off periods with or without dyskinesias; (ii) who were on ≥3 stage on the Hoehn and Yahr scale during on periods and (iii) who received LD at least four times daily in some combination with dopamine agonists (DA), monoamine oxidase B inhibitors (MAO-Bi), catechol-O-methyl transferase inhibitors (COMTi) and/or amantadine
125 cases were considered suitable for device-aided therapies (DAT) [11,12,13,14]—out of which, 83 (66.4%) presented dyskinesias, and 43 (34.4%) were enrolled in the group with complex, disabling dyskinesia associated with severe motor fluctuations
Summary
Parkinson’s disease (PD) is the second-most frequent, progressively worsening neurodegenerative disorder. The continuous delivery into the upper intestine of the levodopa-carbidopa intestinal gel (LCIG) provides a more stable plasma level compared to oral LD administration in patients with nonoptimal control of motor fluctuations. Evidence derived from randomized and open-label clinical trials has proven that LCIG infusion is effective in the treatment of levodopa-induced dyskinesias (LID), despite an overall increase in the mean daily levodopa dose This benefit is thought to be related to a change in LD pharmacokinetics with continuous drug delivery (LCIG therapy has a substantial anti-dyskinetic effect and could be an alternative for APD patients with dyskinesia as a major symptom/cause of disability) [8,9,10]. We do not have knowledge of studies that have evaluated the long-term management of patients with severe motor fluctuations and complex disabling dyskinesias, including diphasic dyskinesia (DID)
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