Continuous jejunal levodopa infusion improves motor function and reduces fluctuations in patients with advanced Parkinson's disease

Long-term levodopa treatment in patients with Parkinson's disease can induce severe motor fluctuations such as wearing-off, sudden-off and hyperkinesia. Since motor fluctuations are, at least in part, due to the pulsatile administration of levodopa, methods to obtain more constant levodopa levels are highly promising. Since October 2004 continuous jejunal levodopa infusion using Duodopa, a stable gel suspension of levodopa/carbidopa, is available in several European countries. Here we report on three further Parkinsonian patients from our department, who received Duodopa treatment in 2006. All three patients had Parkinson's disease for more than 12 years and suffered from disabling motor fluctuations and dyskinesia. In one patient, deep brain stimulation of the subthalamic nucleus was initiated in 2000 but this effect was not sufficient anymore. Patients received a temporary nasoduodenal tube and Duodopa was infused using an ambulatory pump in order to adjust doses for optimal motor control. Patients then received a percutaneous endoscopic gastrostomy with a jejunal tube and adjustments of Duodopa infusion were continued. The percentage of daytime spent in “off“ or “on with disabling dyskinesia“ was reduced by more than 50% in all patients, and clinical global impression was rated as very strong improvement by all patients. In one patient Duodopa infusion was continued at night because of severe night-time akinesia. Two patients, who regained good mobility due to Duodopa therapy suffered from repeated disconnections of the jejunal tube but considered these technical problems negligible as compared to the treatment effect of Duodopa. Overall, continuous jejunal levodopa infusion improved motor function and reduced motor fluctuations and has to be considered as an alternative treatment strategy for patients with advanced Parkinson's disease.