Levodopa/carbidopa intestinal gel can improve both motor and non-motor experiences of daily living in Parkinson's disease: An open-label study. (April 2017)

• Record Type: Journal Article
• Authors: Juhász, Annamária; Aschermann, Zsuzsanna; Ács, Péter; Janszky, József; Kovács, Márton; Makkos, Attila; Harmat, Márk; Tényi, Dalma; Karádi, Kázmér; Komoly, Sámuel; Takáts, Annamária; Tóth, Adrián; Nagy, Helga; Klivényi, Péter; Dibó, György; Dézsi, Lívia; Zádori, Dénes; Annus, Ádám; Vécsei, László; Varannai, Lajos; Kovács, Norbert
• Is Part Of: Parkinsonism & related disorders. Volume 37(2017)
• Page Start: 79
• Page End: 86
• Publication Date: 2017-04
• Subjects: Parkinson's disease -- Enteral infusion -- Duodopa -- Disability -- Dyskinesia; AE Adverse event -- DDS Dopamine dysregulation syndrome -- ESS Epworth Sleepiness Scale -- HRQoL Health-related Quality of Life -- HYS Hoehn-Yahr Stage -- ICD impulse control disorders -- IQR interquartile range -- LCIG levodopa/carbidopa intestinal gel -- LED levodopa-equivalent dosage -- MADRS Montgomery-Asberg Depression Rating Scale -- MC Motor Complications (Part IV of MDS-UPDRS) -- MDS-UPDRS The Movement Disorder Society-sponsored Unified Parkinson's Disease Rating Scale -- ME Motor Examination (Part III of MDS-UPDRS) -- M-EDL Motor Experiences of Daily Living (Part II of MDS-UPDRS) -- MoCA Montreal Cognitive Assessment -- nM-EDL Non-motor Experiences of Daily Living (Part I of MDS-UPDRS) -- NMSS Non-motor Symptoms Scale -- PD Parkinson's disease -- PDSS-2 Parkinson's Disease Sleep Scale 2nd version -- PEG-J percutaneous endoscopic gastrostomy tube with jejunal extension -- PGI-S Patient's Global Impression -Severity -- SD standard deviation -- UDysRS Unified Dyskinesia Rating Scale; Parkinson's disease -- Periodicals; Movement disorders -- Periodicals; Movement Disorders -- Periodicals; Nerve Degeneration -- Periodicals; Nervous System Diseases -- Periodicals; Parkinson Disease -- Periodicals; Tremor -- Periodicals; Parkinson, Maladie de -- Périodiques; Parkinson's disease; 616.833
• DOI: 10.1016/j.parkreldis.2017.02.001
• Languages: English
• ISSNs: 1353-8020

Abstract

Abstract: Background: Levodopa/carbidopa intestinal gel therapy (LCIG) can efficiently improve several motor and non-motor symptoms of advanced Parkinson's disease (PD). The recently developed Movement Disorder Society-sponsored Unified Parkinson's Disease Rating Scale (MDS-UPDRS) improved the original UPDRS making it a more robust tool to evaluate therapeutic changes. However, previous studies have not used the MDS-UPDRS and the Unified Dyskinesia Rating Scale (UDysRS) to assess the efficacy of LCIG. Objectives: Our aim was to determine if the MDS-UPDRS and UDysRS could detect improvement in the experiences of daily living following 1-year LCIG treatment. Methods: In this prospective, multicenter, open-label study, 34 consecutive patients undergoing LCIG treatment were enrolled. Patients were examined twice: prior to LCIG initiation and 12 months later. Impact of PD-related symptoms and dyskinesia was assessed by the MDS-UPDRS and UDysRS. Results: Non-motor Experiences of Daily Living part of MDS-UPDRS improved from 20 (median, interquartile-range, IQR:14–23) to 16 points (median, IQR:12–20, p = 0.044) and the Motor Experiences of Daily Living ameliorated from 24 (median, IQR:20–29) to 18 points (median, IQR:13–25, p = 0.025). Health-related quality of life, measured by PDQ-39, also improved from 35.4 (median, IQR:26.9–50.3) to 27.0 (median, IQR:21.3–31.4) points (p = 0.003). The total score of UDysRS decreased from 47 (median, IQR:36–54) to 34 (median, IQR:21–45) points (p = 0.003). Conclusions: As far as the authors are aware of, our paper is the first to evaluate the impact of LCIG on dyskinesia by the means of UDysRS. Changes in MDS-UPDRS and UDysRS confirm that LCIG treatment can efficiently improve experiences of daily living in advanced PD. Highlights: The indication for LCIG treatment is severe motor fluctuations with troublesome dyskinesia. Currently, there are conflicting data how LCIG modifies the activities of daily living in PD. Moreover, only indirect data are available on its antidyskinetic effect based on patient diaries. Our open-label prospective study is the first utilizing MDS-UPDRS and UDysRS to measure treatment efficacy. Besides dyskinesia, both motor and non-motor experiences of daily living improved significantly.