LONG-TERM INTRADUODENAL INFUSION OF A WATER-BASED LEVODOPA-CARBIDOPA DISPERSION IN VERY ADVANCED PARKINSONS-DISEASE

Objective - To evaluate the effects of continuous duodenal infusion of levodopa over time on the disabling fluctuations in motor performance in advanced parkinsonian patients. It has earlier been demonstrated t hat these fluctuations can be reduced by keeping the plasma concentrat ion of levodopa constant. Material and methods - In view of the low wa ter solubility of levodopa a stable dispersion of the drug was develop ed and used for continuous intraduodenal infusion in patients with adv anced Parkinson's disease. Nine patients were evaluated with respect t o an optimal oral treatment, during nasoduodenal infusion by a portabl e pump and then followed for 6 months to 2 1/2 years when treated via transabdominal infusion, Upon each test occasion, over 2 non-consecuti ve days, objective movement analysis by means of an opto-electronic sy stem was applied every 15-20 min and video recordings performed twice every h. On several test occasions plasma levodopa concentrations were analysed every 15 min. Results - The patients showed improvement and decreased variance of their motor function. In the 2 patients followed over a period of 2 1/2 years levodopa plasma concentration showed red uced fluctuations on infusion and the levodopa consumption as well as mean levodopa plasma concentration decreased. Conclusion - Continuous duodenal infusion of levodopa is an alternative treatment strategy for patients with advanced Parkinson's disease when conventional therapy has failed.