Polyneuropathy associated with duodenal infusion of levodopa in Parkinson's disease: features, pathogenesis and management

Uncini, Antonino; Eleopra, Roberto; Onofrj, Marco

doi:10.1136/jnnp-2014-308586

Cited by 62 publications

(78 citation statements)

References 39 publications

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“…Most of the non‐procedure/device events were typical for levodopa treatment and an elderly population. However, severe acute or subacute polyneuropathy has been reported in some patients 63, 67. Adverse events led to discontinuation in 17% of the patients, most frequently because of complication of device insertion.…”

Section: Device‐aided Treatment Optionsmentioning

confidence: 99%

Algorithms for the treatment of motor problems in Parkinson's disease

Dietrichs

Odin

2017

Acta Neurol Scand

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Several different strategies are effective for medical treatment of motor problems in Parkinson's disease (PD). Many guidelines and evidence‐based reviews are available, but there is no documentation or consensus in favor of just one treatment strategy. This review presents two algorithms that may be helpful when deciding how to treat a PD patient at various stages of the disease. The first algorithm suggests one way to treat PD from the first onset of motor symptoms. It is largely based on treatment recommendations from the Scandinavian countries and Germany. The other algorithm is meant as assistance for choosing among the different device‐aided treatments for advanced PD. There is not sufficient comparative data to recommend one particular line of treatment, neither in early PD nor in advanced disease with motor complications. Individualized treatment is needed for each patient. The current algorithms only represent an alternative for aiding treatment decisions.

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Section: Device‐aided Treatment Optionsmentioning

confidence: 99%

Algorithms for the treatment of motor problems in Parkinson's disease

Dietrichs

Odin

2017

Acta Neurol Scand

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“…Peripheral neuropathy may be related to a vitamin B12 (cobalamin) deficiency, homocysteine neurotoxicity or the neurotoxicity of the levodopa itself [Rajabally and Martey, 2011;Klostermann et al 2012b]. A number of cases of neuropathy have been reported in patients receiving LCIG [Antonini et al 2007;Manca et al 2009;Urban et al 2010;Muller et al 2011;Klostermann et al 2012b;Galazky et al 2014;Lehnerer et al 2014;Merola et al 2015;Uncini et al 2015]. The progression of peripheral neuropathy has been shown to be halted or reversed by vitamin B12 supplementation, vitamin B1 or B6 supplementation, and folate supplementation in some cases [Manca et al 2009;Urban et al 2010;Klostermann et al 2012b;Uncini et al 2015].…”

Section: Safety Profilementioning

confidence: 99%

“…A number of cases of neuropathy have been reported in patients receiving LCIG [Antonini et al 2007;Manca et al 2009;Urban et al 2010;Muller et al 2011;Klostermann et al 2012b;Galazky et al 2014;Lehnerer et al 2014;Merola et al 2015;Uncini et al 2015]. The progression of peripheral neuropathy has been shown to be halted or reversed by vitamin B12 supplementation, vitamin B1 or B6 supplementation, and folate supplementation in some cases [Manca et al 2009;Urban et al 2010;Klostermann et al 2012b;Uncini et al 2015]. In a study that assessed PD patients for up to 2 years after commencing LCIG treatment, patients with peripheral neuropathy received vitamin B1 and B12 supplementation and showed clinical improvement and sometimes, stability at subsequent assessments [Merola et al 2015].…”

Section: Safety Profilementioning

confidence: 99%

“…In a study that assessed PD patients for up to 2 years after commencing LCIG treatment, patients with peripheral neuropathy received vitamin B1 and B12 supplementation and showed clinical improvement and sometimes, stability at subsequent assessments [Merola et al 2015]. Suggested preventative measures against peripheral neuropathy include laboratory testing for vitamin B12 and folate deficiency prior to starting LCIG, with supplementation before and during LCIG treatment for patients at risk of vitamin deficiency [Merola et al 2015;Uncini et al 2015]. Electrophysiological assessment before and at intervals during LCIG therapy has also been proposed to reduce the risk of peripheral neuropathy or identify its onset [Merola et al 2015;Uncini et al 2015].…”

Section: Safety Profilementioning

confidence: 99%

“…Suggested preventative measures against peripheral neuropathy include laboratory testing for vitamin B12 and folate deficiency prior to starting LCIG, with supplementation before and during LCIG treatment for patients at risk of vitamin deficiency [Merola et al 2015;Uncini et al 2015]. Electrophysiological assessment before and at intervals during LCIG therapy has also been proposed to reduce the risk of peripheral neuropathy or identify its onset [Merola et al 2015;Uncini et al 2015]. In the phase III double-blind study, symptoms associated with neuropathy were reported in one patient that received LCIG and three patients that received oral levodopa-carbidopa [Olanow et al 2014].…”

Section: Safety Profilementioning

confidence: 99%

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Levodopa-carbidopa enteral suspension in advanced Parkinson’s disease: clinical evidence and experience

Virhammar

Nyholm

2016

Ther Adv Neurol Disord

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Abstract:The duration of action of oral levodopa becomes shorter as Parkinson's disease (PD) progresses. Patients with advanced PD may develop potentially disabling motor fluctuations and abnormal involuntary movement (dyskinesia), which cannot be managed with optimized oral or transdermal PD medications. The progressively worsening symptoms can have a substantial impact on the patient quality of life (QoL). Levodopa-carbidopa intestinal gel (LCIG) is delivered continuously via a percutaneous endoscopic gastrostomy with a jejunal extension (PEG-J). LCIG is licensed for the treatment of levodopa-responsive advanced PD in individuals experiencing severe motor fluctuations and dyskinesia when available combinations of antiparkinsonian medications have not given satisfactory results. Initial evidence for the efficacy and tolerability of LCIG came from a number of small-scale studies, but recently, three prospective studies have provided higher quality evidence. A 12-week double-blind comparison of LCIG with standard levodopa therapy, a 52-week open-label study extension of the double-blind study, and a 54-week open-label safety study, demonstrated significant improvements in 'off' time and 'on' time without troublesome dyskinesia, and QoL measures that were maintained in the longer term. There are also observations that LCIG may be effective treatment for nonmotor symptoms (NMS) although the evidence is limited. There is a need for further research on the efficacy of LCIG in reducing NMS, dyskinesia and improving QoL. This review surveys the clinical evidence for the effectiveness and tolerability of LCIG in the management of advanced PD and highlights some practical considerations to help optimize treatment.

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Polyneuropathy monitoring in Parkinson's disease patients treated with levodopa/carbidopa intestinal gel

et al. 2021

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Objectives: Levodopa-carbidopa-intestinal-gel (LCIG) infusion is an effective treatment for advanced PD with motor fluctuations. Polyneuropathy occurs as a complication in 10-15% of patients. We wanted to assess the frequency of polyneuropathy in Finnish advanced Parkinson's disease (PD) patients with continuous LCIG infusion, and the value of different clinical monitoring parameters during follow-up. Materials and methods: Patient records of PD patients started on LCIG infusion atHelsinki University Hospital who received nerve conduction studies at baseline and 6 months after treatment initiation were reviewed for epidemiological information, mini mental state examination, baseline and 6 months' UPRDS-III, weight, body mass index, levodopa dose (LD), plasma homocysteine levels, folate, vitamin B6 and B12.Results: Out of 19 patients (n = 6 on B-vitamin substitution), two (10.5%) developed new-onset polyneuropathy after initiation of LCIG therapy (n = 0 with vitamin substitution). Neuropathy was associated with significant weight loss (BMI reduction > 1.5), but not with other monitoring parameters. Homocysteine rose significantly in patients not substituted with B-vitamin complex, but not in patients with B-vitamin substitution. Homocysteine changes correlated with LD changes in the absence of vitamin B substitution. After oral B-vitamin substitution, both patients' polyneuropathy remained electrophysiologically and clinically stable.Conclusions: Rates of polyneuropathy in Finnish PD patients with LCIG treatment are comparable to previous studies. Patients' weight should be included in regular follow up monitoring and can be used for patient self-monitoring. Vitamin B substitution appears to reduce coupling between levodopa dose and homocysteine and may be useful to prevent polyneuropathy related to LCIG.

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Polyneuropathy associated with duodenal infusion of levodopa in Parkinson's disease: features, pathogenesis and management

Cited by 62 publications

References 39 publications

Algorithms for the treatment of motor problems in Parkinson's disease

Algorithms for the treatment of motor problems in Parkinson's disease

Levodopa-carbidopa enteral suspension in advanced Parkinson’s disease: clinical evidence and experience

Polyneuropathy monitoring in Parkinson's disease patients treated with levodopa/carbidopa intestinal gel

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