Infusión intraduodenal de levodopa

Abstract

In the advanced stages of Parkinson's disease (PD), the conventional orally-administered pharmacological treatment can prove to be insufficient to control the motor complications associated with the disease. One of the causes involved in the genesis of the motor fluctuations that are observed in PD is the variable absorption of the medication due to an irregular or erratic emptying of the gastric content. Today, a method of therapy is now available that allows levodopa to be administered directly into the duodenum at a continuous rate by a perfusor. The medication is applied through a duodenal catheter implanted by means of a percutaneous endoscopic gastrostomy. This new form of administration has been marketed under the name of Duodopa ®, which is a pharmaceutical form of levodopa in a micronised suspension in a thickening gel consisting of sodium carmelose. It is presented in combination with levodopa (20 mg/mL) and a dopa decarboxylase inhibitor, carbidopa (5 mg/mL). Duodopa has proved to be effective in reducing the percentage of off time and in diminishing the periods with disabling dyskinesias. This therapy has also proved to be useful for relieving certain non-motor aspects associated with PD and presents fewer limitations regarding indication for advanced PD patients than those that usually exist for the case of deep brain stimulation. Although the therapy has proved to be effective, it is not free of complications arising from malfunctioning of the infusion system or in relation to the percutaneous endoscopic gastrostomy.

Cognitive Impairment Associated with Parkinson's Disease: Role of Mitochondria

“…rotigotine), intraduodenal ( e.g . infusion of leveodopa) [ 104 ] are used for continuous delivery therapies [ 103 ]. Adenosine receptor antagonists, Coenzyme Q10, creatine, Isradipine, protein aggregation inhibitors, stem cell therapy and gene therapy are under preclinical and clinical investigations in PD [ 103 ].…”

Clinical Management of Patients With Advanced Parkinson’s Disease Treated With Continuous Intestinal Infusion of levodopa/carbidopa

“…• Symptoms suggesting peripheral neuropathy. There have been several reports of Guillain-Barré syndrome [5,71] axonal polyneuropathy or other complications in the setting of deficiency of vitamin B 12 or other B vitamins [62,[70][71][72][73][74][75][76]. In the event of acute or subacute and moderateto-severe clinical symptoms, patients should be admitted to hospital and etiology should be established, discontinuing the treatment if required.…”

“…It is important to identify complications that may improve upon dose reduction (additional symptomatic treatment may sometimes be required). Potential complications are described in Box 3 & Figure 3 [1,5,35,62,[64][65][66][67][68][69][70][71][72][73][74][75][76].…”