Abstract
Parkinson’s disease (PD) is a highly debilitating, progressive disease that responds favourably to therapeutic doses of levodopa, the gold standard treatment for PD. Treatment of PD is largely determined by the phase of the disease the patient is currently experiencing: early, middle or advanced. Initially, there is good response to medication and adjuvant therapeutic strategies, but after six to eight years motor and non-motor complications develop. These are produced in part by erratic gastric emptying leading to irregular absorption and fluctuating plasma levels of levodopa, and hence an unstable response. At this point, clinical fluctuations are progressively more difficult to control and, consequently, the quality of life of patients deteriorates. The development of deep brain stimulation for the treatment of these long-term PD patients has been a major step forward. More recently, a novel gel form of levodopa/carbidopa has enabled infusion through percutaneous endoscopic gastrostomy directly into the duodenum. This system avoids the gastric step, enhancing absorption of the drug and favouring stable plasma levels of levodopa. The advantages of this approach have since been considered in several clinical studies. In order to investigate the clinical effects of intraduodenal levodopa infusions on motor fluctuations and to explore the safety issues, we have conducted a multicentre prospective study in the area of Barcelona (Catalonia, Spain). The preliminary results of this study in 26 patients are presented here and discussed together with the recommended management, from our experience, of the most frequent adverse effects and mechanical complications of the infusion device that we have observed.