Continuous jejunal levodopa infusion in patients with advanced Parkinson disease:: Practical aspects and outcome of motor and non-motor complications

Objectives: We report here on the experience with continuous jejunal levodopa infusion in 13 German parkinsonian patients who have motor and nonmotor complications despite individually optimized oral treatment. The tolerability, efficacy, and the need for dose adjustment of levodopa infusion were followed-up prospectively. Thereby, we describe clinically relevant details for how to successfully initiate and handle this new treatment strategy. Methods: Thirteen patients with advanced Parkinson disease (PD) who have motor fluctuations and dyskinesia were switched off their conventional PD medication to continuous levodopa infusion and followed-up within a maximum period of 12 months. Results: Time in off represented a mean of 50% ( +/- 14; n= 13) of awake time before levodopa infusion and was reduced to a mean of 11% (+/- 9; n = 11) of awake time after 6 months. Time in on with disabling dyskinesias represented a mean of 17% (+/- 15; n = 13) of awake time before levodopa infusion and was reduced to a mean of 3% (+/- 6; n = 11) of awake time after 6 months, thereby increasing the time in good on state. A positive effect on nonmotor symptoms (anxiety, sleep, disturbances) was also observed. In most cases, dose adjustment was required within the first 6 months (predominantly after months 1-3). The therapy was safe and effective. However, problems with the technical device were common. Conclusions: Continuous jejunal levodopa infusion is an effective and feasible alternative treatment option for patients with advanced PD who can cope with and tolerate the device.