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Brain Behav. 2017 Jun 5;7(7):e00737. doi: 10.1002/brb3.737. eCollection 2017 Jul.

Problems related to levodopa-carbidopa intestinal gel treatment in advanced Parkinson's disease.

Author information

1
Department of Surgery Unit of Therapeutic Endoscopy Helsinki University Helsinki Finland.
2
Clinical Neurosciences, Neurology Helsinki University Helsinki Finland.
3
Department of Neurology Helsinki University Hospital and Helsinki University Helsinki Finland.
4
HUS Medical Imaging Center Helsinki University Helsinki Finland.

Abstract

BACKGROUND:

Continuous levodopa-carbidopa intestinal gel (LCIG) diminishes daily "off" time and dyskinesia in patients with advanced Parkinson's disease (PD). Complications are common with percutaneous endoscopic gastrostomy with a jejunal extension tube (PEG-J).

AIM OF THE STUDY:

To report the clinical outcome of LCIG in patients with advanced PD in the years 2006-2014 at Helsinki University Hospital.

PATIENTS AND METHODS:

Levodopa-carbidopa intestinal gel treatment started following PEG-J placement in patients with advanced PD after successful in-hospital LCIG trial with a nasojejunal tube. Demographics, PEG-J procedures, discontinuation of LCIG, complications and mortality were retrospectively analyzed.

RESULTS MEAN SD:

Sixty patients with advanced PD [age 68(7) years; duration of PD: 11(4) years] had LCIG treatment for 26(23) months. The majority of patients with advanced PD were satisfied with the LCIG treatment. For 51 patients (85%), the pump was on for 16 hr a day, and for nine patients (15%) it was on for 24 hr a day. After 6 months, the levodopa-equivalent daily dose (LEDD) had increased by 30% compared to pre-LCIG LEDD. Sixty patients underwent a total of 156 PEG-J procedures, and 48 patients (80%) had a total of 143 complications. Forty-six patients (77%) had 119 PEG-J or peristomal complications, and 22 patients (37%) had a total of 25 other complications. The most common complications were accidental removal of the J-tube in 23 patients (38%) and ≥5% weight loss in 18 patients (30%). Fifteen patients discontinued the LCIG after 21 (21) months. At the end of the follow-up period of 33(27) months, 38 patients were still on LCIG and nine (15%) had died.

CONCLUSION:

Most patients were satisfied with LCIG treatment. A few patients lost weight whereas the majority had complications with PEG-J. When LCIG treatment is carried out, neurological and endoscopic units must be prepared for multiple endoscopic procedures.

KEYWORDS:

LCIG; PEG‐J; Parkinson's disease; complication; duodopa; mortality; weight loss

PMID:
28729942
PMCID:
PMC5516610
DOI:
10.1002/brb3.737
[Indexed for MEDLINE]
Free PMC Article

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