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

Abstract

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.

Adverse effects of levodopa/carbidopa intrajejunal gel treatment: A single‐center long‐term follow‐up study

“…This surprising finding may be explained by hypothesis that patients who require early LCIG treatment have more severe disease and therefore may require higher doses of LCIG resulting in more pronounced vitamin B12 deficiency. 28,29 Furthermore, higher alpha-synuclein load may be present in the peripheral nervous system in those cases, which may have further deleterious effect on the peripheral nervous system. 29 Many prior studies addressed high frequency of device and PEG-J-related AEs.…”

“…28,29 Furthermore, higher alpha-synuclein load may be present in the peripheral nervous system in those cases, which may have further deleterious effect on the peripheral nervous system. 29 Many prior studies addressed high frequency of device and PEG-J-related AEs. [12][13][14][15][16] These AEs were previously reported to be most frequent in the first 2 years after the procedure (35% of patients each year) and declined to 20% in the fifth year of treatment.…”

“…A short disease duration at the beginning of LCIG treatment was shown to be a predisposition for B12‐related polyneuropathy. This surprising finding may be explained by hypothesis that patients who require early LCIG treatment have more severe disease and therefore may require higher doses of LCIG resulting in more pronounced vitamin B12 deficiency 28,29 . Furthermore, higher alpha‐synuclein load may be present in the peripheral nervous system in those cases, which may have further deleterious effect on the peripheral nervous system 29 …”

“… 28 , 29 Furthermore, higher alpha‐synuclein load may be present in the peripheral nervous system in those cases, which may have further deleterious effect on the peripheral nervous system. 29 …”

Acute/subacutae demyelinating polyneuropathy in Parkinson’s Disease patients on levodopa-carbidopa intestinal gel therapy: systematic review with new case report

“…Ultimately, nine papers were identified (including one in Spanish) -four with prospective assessment [10,12,15,16] and five case reports [11,13,[17][18][19]. Publications were identified where such cases were only mentioned (providing an additional 33 cases) without any detailed information, and therefore they were not analysed [20][21][22][23][24]. Finally, the data of 15 patients was collected.…”