Duodenal levodopa gel - an alternative therapy in advanced PD

A levodopa gel, intraduodenally infused, is superior to traditional combination therapy for advanced Parkinson's disease (PD), according to Swedish investigators.The authors compared individualised combination therapy to continuous duodenal levodopa/carbidopa infusion in a randomised, crossover study. The trial included 24 patients with advanced, idiopathic PD who continued to experience motor fluctuations and dyskinesia in spite of taking individually-optimised treatment. Two neurologists blinded to the treatment group viewed video recordings and rated motor function in each participant. Self-assessment of motor function and quality of life were recorded using an electronic diary. The authors describe the innovative use of technology to capture the data: "Patients were alerted by an alarm in the computer to respond to questions on the touch screen four times daily?The questions were to be responded to within 20 minutes. The responses were stored within the device and transferred to a centralized electronic database via the cellular phone." The authors report that the duodenal infusion led to increased "on" time, as assessed by the neurologists. There was also a decrease in the "off" state and no increase in dyskinesia, they say. Median Unified Parkinson's Disease Rating Scale score decreased from 53 to 35 with the infusion and quality of life also improved.In an editorial appearing in the same issue of Neurology, Dr Mouradian says, "Although the findings of this study are not surprising, the delivery mode is encouraging for a group of parkinsonian patients who fail repeated efforts to stabilize their motor response with conventional therapies." Dr Mouradian points out that the lack of a placebo arm is a limitation, particularly since dopamine is released in the striatum of PD patients as the result of a placebo effect. However, the authors contend that the lack of a placebo arm in the study should not greatly influence results. They say, "...it seems unlikely that patients with very advanced PD would be improved for 3 weeks only because of the placebo effect." Reference...