The source of this article is Reuter's Health: http://tinyurl.com/7dy5a

Continuous L-dopa delivery useful for Parkinson's
Thu Jun 16, 2005 08:39 AM ET

By Karla Gale
NEW YORK (Reuters Health) - Giving the anti-Parkinson's drug levodopa 
continuously through a naso-gastric tube is better than the pill form of 
the drug at reducing the movement problems seen with the disease, according 
to a report in the Archives of Neurology.

With the continuous approach, a narrow tube is inserted through the nose 
and then advanced into the intestine under x-ray guidance. Once in 
position, a small amount of liquid levodopa is pumped into the intestine on 
a continuous basis.

This infusion method of delivering levodopa is thought to work better than 
simply taking a pill because drug levels in the body don't fluctuate as 
much. With a pill, the periodic rise and drop in drug levels can actually 
have a damaging effect on nerve cells and lead to permanent movement problems.

"Levodopa-induced (movement problems) are the major reason why patients 
have surgery for Parkinson's," Dr. C. Warren Olanow, from Mount Sinai 
School of Medicine in New York, told Reuters Health. "What we're trying to 
do is figure out how to prevent these adverse events so patients won't need 
surgery."

In the present study, Olanow's group switched six patients with advanced 
Parkinson's disease from levodopa pills to naso-gastric infusions of the 
drug and then evaluated the effect on movement.

Changing to the infusions significantly reduced the movement problems seen 
in the patients and improved their ability to perform routine activities of 
daily living.

Unfortunately, the problem with infusions is that they're inconvenient, 
Olanow noted. "What we want to do is figure out why infusion is better than 
(pills)" and maybe then a way can be found to give levodopa that better 
suits the body's physiology.

He theorizes that giving levodopa pills in combination with drugs called 
COMT inhibitors may reproduce the benefits seen with infusion.

"We've shown that when monkeys take levodopa with the COMT inhibitor they 
have less (movement problems) than if they take levodopa alone," Olanow 
said. He and his associates are now in the planning stages of a large trial 
to test this strategy in humans.

SOURCE: Archives of Neurology, June 2005.



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