 |
 |
FROM WE MOVE News: "New Method of Continuous Levodopa Delivery for People with Parkinson’s Disease People with Parkinson’s disease (PD) not only have tremor, slowness of movement, stiffness, and balance or coordination problems but also may develop motor complications, which include times in which the drug does not have it desired effect (called “off” periods) and the development of uncontrolled movements (called dyskinesias). These motor complications are believed to be the result of the worsening of the disease as well as rising and falling (fluctuations in) blood levels of levodopa, the standard treatment for PD. (Please click here for background information.) In an attempt to provide a more constant blood level of levodopa and to lessen the motor complications, a new method of levodopa delivery has been developed. The method involves the continuous infusion of Duodopa®, a gel preparation of levodopa/carbidopa, via a portable pump into the stomach or small intestine. At the Eighth International Congress of Parkinson’s Disease and Movement Disorders, two groups of researchers presented their findings from studies on the use of Duodopa in patients with advanced PD and severe motor fluctuations or dyskinesias. Dr. Nyholm and his colleagues in Sweden, the United States, and Norway studied the tolerance to and safety, effectiveness, and dosage of Duodopa in 58 patients who received the drug via nasoduodenal, gastrostomy, or jejunostomy tube over an average treatment time of slightly more than four years. The infusion of Duodopa for 16 hours per day plus oral levodopa at night resulted in “much improved” or “improved” ratings in motor fluctuations from baseline in at least 90% of the patients; dyskinesias were reported to be “much improved” or “improved” as well. Of the 65 total patients in the study, 58 elected to remain on this form of therapy for the long term, with 52 having been treated for at least one year. Complications occurred on average once or twice per year per patient and typically involved blockage or displacement of the tube. Side effects were similar to those observed with oral levodopa preparations. The average total daily dose of Duodopa plus nighttime levodopa decreased 77 mg as compared to the baseline dose of levodopa. Nyholm D, Lewander T, Johansson A, LeWitt PA, Lundqvist C, Aquilonius S-M. Intraduodenal infusion of a gel suspension of levodopa/carbidopa, Duodopa®, in advanced Parkinson’s disease: safety, tolerability, efficacy and dosage. Presented at the Eighth International Congress of Parkinson’s Disease and Movement Disorders in Rome, Italy, June 14-17, 2004, and published in Mov Disord 2004;19(suppl 9):S177. In another study from Dr. Nyholm and researchers in Sweden, 24 patients participated in a cross-over study in which they were randomly assigned to receive Duodopa via nasoduodenal tube during the day for three weeks or their optimized, individual, combination, oral therapy for three weeks; they then switched to the other form of treatment for another three weeks. During the cross-over study, the patients kept a real-time electronic diary, noting motor functions and quality of life. In addition, the researchers videotaped the patients every 30 minutes during an eight-hour period on each of two days in each of the treatment arms. Observers, who were not aware of which form of treatment the patients were taking, reviewed the videotapes and assigned a treatment-response score (-3 for severe parkinsonism to 0 for normal to +3 for severe dyskinesia), based upon the patient’s motor functioning, as well as a score on the Unified Parkinson Disease Rating Scale. The results showed that the motor scores from -1 to +1 (which reflect a near-normal state) were 81% with the use of optimized, individual, combination, oral therapy and 100% with the use of Duodopa. The Unified Parkinson Disease Rating Scale scores reflected similar improvements with the use of Duodopa therapy, shifting from a score of 53 after oral therapy to 35 after Duodopa. Patients rated their quality of life as significantly improved with the use of Duodopa. This study was funded by NeoPharma, the manufacturer of Duodopa. Nyholm D, Dizdar N, Nilsson Remahl I, Holmberg B, Aquilonius S-M, Asmark H. Eneeral levodopa infusion as monotherapy is superior to conventional oral treatment of advanced Parkinson’s disease. Presented at the Eighth International Congress of Parkinson’s Disease and Movement Disorders in Rome, Italy, June 14-17, 2004, and published in Mov Disord 2004;19(suppl 9):S178-9. http://www.imakenews.com/wemovenews/e_article000305691.cfm?x=b3BdH5h,b23F 7l0n ---------------------------------------------------------------------- To sign-off Parkinsn send a message to: mailto:[log in to unmask] In the body of the message put: signoff parkinsn