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Continuous levodopa for advanced Parkinson's disease.

Lundqvist C - Neuropsychiatr Dis Treat (2007)

Bottom Line: The effect of the treatment may be tested individually via naso-duodenal administration before a decision is made whether to continue with permanent treatment.Focus is mainly on the clinical studies of continuous levodopa infusion therapies, especially enteral administration of levodopa/carbidopa gel.The place of enteral levodopa/carbidopa gel treatment among the other treatment methods is also discussed.

View Article: PubMed Central - PubMed

Affiliation: HØKH - Helse Øst Health Services, Research Centre, Akershus University Hospital, Lørenskog, Norway, and Dept. Neurology, Ulleval university Hospital, Oslo, Norway. christofer.lundqvist@medisin.uio.no

ABSTRACT
Parkinson's disease is characterized by the progression of the disease from the early stages where it still has little functional consequence for afflicted patients, to an advanced stage disease with large consequences in terms of function, quality of life and individual and societal costs. Motor fluctuations and symptoms of levodopa overdosage may occur in parallel with increasing Parkinsonian symptoms. This leads to a narrower therapeutic window which causes problems with traditional oral medication. Various ways of optimizing oral treatment should be tried but often have limited effects. In addition to the previous alternatives of neurosurgery (especially deep brain stimulation of the subthalamic nuclei) and continuous apomorphine treatment there is now also the alternative of continuous enteral levodopa administration via a trans-abdominal tube. The effect of the treatment may be tested individually via naso-duodenal administration before a decision is made whether to continue with permanent treatment. In the present article, the challenges to treatment of Parkinson's disease in these phases are described as well as the various treatment alternatives available. Focus is mainly on the clinical studies of continuous levodopa infusion therapies, especially enteral administration of levodopa/carbidopa gel. The place of enteral levodopa/carbidopa gel treatment among the other treatment methods is also discussed.

No MeSH data available.


Related in: MedlinePlus

The administration system used for continuous enteral administration of levodopa/carbidopa gel (Duodopa®).
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Related In: Results  -  Collection


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f1-ndt-3-335: The administration system used for continuous enteral administration of levodopa/carbidopa gel (Duodopa®).

Mentions: The levodopa/carbidopa gel developed by Neopharma AB, Uppsala, Sweden (presently Solvay Pharma GmbH, Hannover, Germany) is a carboxymethylcellulose aqueous gel containing 20 mg/mL of levodopa and 5 mg/mL of carbidopa. It is supplied in cassettes containing 100 mL of gel solution (2 g levodopa). The content of the cassettes is administered by a portable infusion pump (CADD-Legacy-Duodopa, Smiths Medical, MN, USA) and via a naso-duodenal or transabdominal duodenal tube to the duodenum proximal jejunum (see Figure 1). For short-term treatment and clinical test periods, the naso-duodenal route is used to avoid surgery. Fluoroscopy is usually used for correct placement of the tube. For longer-term treatment, usually after such a test phase, the tube is introduced directly into the gastric tract by means of PEG (percutaneous endoscopic gastrostomy) surgery and guided to the same position in the duodenum/jejunum with the gastroscope. The position is later controlled by fluorography. All surgical procedures are performed using local anesthesia. The pump is carried in a special bag or harness with infusion ongoing throughout the hours of the day (usually approx. 16 hours). The pump is usually stopped at night and a new medication cassette is connected every morning.


Continuous levodopa for advanced Parkinson's disease.

Lundqvist C - Neuropsychiatr Dis Treat (2007)

The administration system used for continuous enteral administration of levodopa/carbidopa gel (Duodopa®).
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2654791&req=5

f1-ndt-3-335: The administration system used for continuous enteral administration of levodopa/carbidopa gel (Duodopa®).
Mentions: The levodopa/carbidopa gel developed by Neopharma AB, Uppsala, Sweden (presently Solvay Pharma GmbH, Hannover, Germany) is a carboxymethylcellulose aqueous gel containing 20 mg/mL of levodopa and 5 mg/mL of carbidopa. It is supplied in cassettes containing 100 mL of gel solution (2 g levodopa). The content of the cassettes is administered by a portable infusion pump (CADD-Legacy-Duodopa, Smiths Medical, MN, USA) and via a naso-duodenal or transabdominal duodenal tube to the duodenum proximal jejunum (see Figure 1). For short-term treatment and clinical test periods, the naso-duodenal route is used to avoid surgery. Fluoroscopy is usually used for correct placement of the tube. For longer-term treatment, usually after such a test phase, the tube is introduced directly into the gastric tract by means of PEG (percutaneous endoscopic gastrostomy) surgery and guided to the same position in the duodenum/jejunum with the gastroscope. The position is later controlled by fluorography. All surgical procedures are performed using local anesthesia. The pump is carried in a special bag or harness with infusion ongoing throughout the hours of the day (usually approx. 16 hours). The pump is usually stopped at night and a new medication cassette is connected every morning.

Bottom Line: The effect of the treatment may be tested individually via naso-duodenal administration before a decision is made whether to continue with permanent treatment.Focus is mainly on the clinical studies of continuous levodopa infusion therapies, especially enteral administration of levodopa/carbidopa gel.The place of enteral levodopa/carbidopa gel treatment among the other treatment methods is also discussed.

View Article: PubMed Central - PubMed

Affiliation: HØKH - Helse Øst Health Services, Research Centre, Akershus University Hospital, Lørenskog, Norway, and Dept. Neurology, Ulleval university Hospital, Oslo, Norway. christofer.lundqvist@medisin.uio.no

ABSTRACT
Parkinson's disease is characterized by the progression of the disease from the early stages where it still has little functional consequence for afflicted patients, to an advanced stage disease with large consequences in terms of function, quality of life and individual and societal costs. Motor fluctuations and symptoms of levodopa overdosage may occur in parallel with increasing Parkinsonian symptoms. This leads to a narrower therapeutic window which causes problems with traditional oral medication. Various ways of optimizing oral treatment should be tried but often have limited effects. In addition to the previous alternatives of neurosurgery (especially deep brain stimulation of the subthalamic nuclei) and continuous apomorphine treatment there is now also the alternative of continuous enteral levodopa administration via a trans-abdominal tube. The effect of the treatment may be tested individually via naso-duodenal administration before a decision is made whether to continue with permanent treatment. In the present article, the challenges to treatment of Parkinson's disease in these phases are described as well as the various treatment alternatives available. Focus is mainly on the clinical studies of continuous levodopa infusion therapies, especially enteral administration of levodopa/carbidopa gel. The place of enteral levodopa/carbidopa gel treatment among the other treatment methods is also discussed.

No MeSH data available.


Related in: MedlinePlus