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E-MOVE reports from the 12th International Congress of Parkinson's Disease and Movement Disorders, sponsored by the Movement Disorders Society and held in Chicago June 22-26, 2008. Abstract numbers and pages refer to abstracts published in Movement Disorders 2008;23(suppl 1). Duodenal delivery of levodopa (Duodopa®) is a valuable treatment option in advanced Parkinson's disease, according to a series of studies presented at the Movement Disorders meeting. In this therapy, levodopa/carbidopa is held in a reservoir that the patient carries around like a purse, and is delivered via a percutaneous endoscopic gastrostomy (PEG) tube through the patient's abdomen into the small intestine. A key advance over earlier attempts with this therapy was the development of a gel formulation, allowing the same amount of drug to be delivered in a much smaller volume of solution, making the reservoir smaller and less cumbersome to transport. Duodopa is typically used in patients who have developed motor fluctuations and dyskinesias that can no longer be managed by adjusting oral medications, and who are not candidates for deep brain surgery, such as those with cognitive impairment, or who elect not to undergo surgery. Continuous delivery, versus the pulsatile delivery from oral medications, offers the potential benefit of smoothing out dopamine concentrations in the brain to provide more tonic stimulation, mimicking the brain's own regulation of dopamine release. Although no comparative figures were offered at the meeting, Duodopa is expensive, and is likely to cost more over the long term that DBS, according to some researchers E-MOVE spoke with. Mancini et al. prospectively studied 37 patients for 3 years on Duodopa therapy. Off periods and dyskinesias fell by 80% compared to baseline, with no change in daily levodopa intake. There was a 60% improvement in activities of daily living, and significant improvements in several domains of the PDQ-39 quality of life measure. Ten patients withdrew for adverse events or poor compliance, and 8 who did not withdraw had PEG-related complications. Puente et al. studied 25 patients with mean disease duration of 17 years. Twenty-two responded to a nasoduodenal test regimen, and received PEG placement. Over a mean follow-up of 13 months, 3 patients withdrew due to adverse effects. Off time decreased from 63% to 12% of the waking day, while there was no change in either amount of severity of dyskinesias. Total "on" UPDRS score improved by 15 points. The same researchers (de Fabregues et al.) reported the following complications in their 22 patients: --local peritonitis (3) --PEG stoma dermatitis (9) and granuloma (7) --duodenal ulcer (2; 1 withdrew) In addition, connection breakages or failures occurred in 20 patients. Obstructions or tube migrations were also common. Drug-related effects included development of biphasic dyskinesias in 3 patients, 2 of whom withdrew from treatment, and visual hallucinations in 3. The authors conclude, "Treatment with duodenal levodopa infusion entails adverse events that require hospital consultation and patient's follow-up in a multidisciplinary specialized unit. Nevertheless, only 3 out of 22 patients were withdrawn from treatment in this two years follow-up." Finally, Winzer et al. report a case of dopamine dysregulation syndrome improved by duodenal infusion. A 64-year-old male with PD for 14 years developed severe hypersexuality and spending on sex habits, along with hallucinations and confusion, while on levodopa and a dopamine agonist. A removal of the dopamine agonist did not improve his condition, and in addition his motor fluctuations worsened. A switch to Duodopa led to stabilization of motor fluctuations, reduction in off time, improvement in dyskinesias, and disappearance of hallucinations, and rapidly led to near-normalization of the hypersexuality. ---------------------------------------------------------------------- To sign-off Parkinsn send a message to: mailto:[log in to unmask] In the body of the message put: signoff parkinsn