Intrajejunal Levodopa Versus Conventional Therapy in Parkinson Disease

• DOI: 10.1097/wnf.0b013e3182613dea
• Publication Date: 2012-07-20T19:14:08Z
• Authors: Prashanth Reddy; Pablo Martinez-Ma...; Alexandra Rizos; Anne Martin; Guy C. Faye; Ian Forgacs; Per Odin; Angelo Antonini; K. Ray Chaudhuri
• Keywords: Male; 610; Parkinson Disease; Middle Aged; motor; 3. Good health; Parkinson disease; Cohort Studies; Levodopa; 03 medical and health sciences; Jejunum; Treatment Outcome; 0302 clinical medicine; quality of life; Motor Skills; Surveys and Questionnaires; Quality of Life; Humans; Female; intrajejunal L-dopa infusion; nonmotor; Aged; Follow-Up Studies

Seventeen patients with advanced Parkinson disease (PD) were treated with intrajejunal L-dopa infusion (IJL) and compared with a matched group of 9 patients (termed comparator [C]) not given IJL because of funding restriction by primary care trusts (PCTs) in the UK, although considered to be clinically eligible for IJL. Assessments were baseline and follow-up (6 months) with Hoehn and Yahr staging, unified PD rating scale (UPDRS-III and UPDRS-IV), Parkinson disease questionnaire (PDQ-8, quality of life [QoL]) and nonmotor symptom scale (NMSS).Baseline characteristics were comparable between the groups. The IJL-treated group showed highly significant improvements in UPDRS-III (P = 0.005), UPDRS-IV (P = 0.0004), total NMSS score (P = 0.004), and QoL (P = 0.01), whereas the C group showed no change in these parameters. A large effect size of IJL was seen in treated patients for UPDRS-III (1.13), UPDRS-IV (1.52), NMSS score (0.82), and QoL (1.12), whereas continuing conventional treatment registered no effect in C.This study confirms the robust effect of IJL on motor and, in particular, nonmotor symptoms and QoL in advanced PD as described in open-label studies but additionally points to the need for such treatment in those denied this therapy because of centrally dictated funding policies leading to inequalities in health care.