Objective: The aim of the study was to determine whether the daily dose of levodopa equivalent daily dose (LEDD) before and after starting levodopa/carbidopa intestinal gel (LCIG) treatment may be a risk factor for acute polyneuropathy (AP).
Background: LCIG administered by a jejunal tube via gastrostomy connected to the extracorporeal pump is a device – aided treatment for advanced Parkinson’s disease (PD). A rare but serious complication of LCIG is a development of severe acute polyneuropathy requiring immediate discontinuation of LCIG.
Method: We have retrospectively analyzed data from 183 LCIG patients (80 women, mean age 67.25 ± (SD) 7.95 years) from seven movement disorders centers in the Czech and Slovak Republics. In addition to clinical and demographic data, we determined LEDD immediately before LCIG treatment (LEDD 0) and three months after its initiation (LEDD 3M). In the case of AP development, also the duration of LCIG treatment before discontinuation was also noticed.
Results: Out of all study group, 6 patients (5 women) developed acute polyneuropathy during the first eleven months of LCIG treatment.
In AP patients, the median LEDD increased from a LEDD 0 1898 mg (IQR 1484 – 2167 mg) to a LEDD 3M 3015 mg (2219-3171 mg). In other LCIG patients (without AP) increased the median LEDD 0 from 1362 mg (1118-1750 mg, no significant difference between centers, p = 0.97) to LEDD 3M 1582 mg (1207-2081 mg differing significantly between centers (p <0.0001).
AP was clearly associated with a higher LEDD 0 (threshold 1823 mg, sensitivity 67% and specificity 80%), higher LEDD 3M (threshold 2605 mg, sensitivity 83% and specificity 93%) and its overall increase (sensitivity 100% and specificity 71%).
Conclusion: High LEDD before LCIG treatment and especially high LEDD after three months of LCIG treatment seem to be a clear risk factors for acute polyneuropathy development. This fact should be considered during LCIG indication and initiation.
To cite this abstract in AMA style:
P. Havránková, R. Jech, M. Baláž, V. čapek, K. Gmitterová, M. Grófik, V. Haň, M. Kaiserová, P. Kaňovský, J. Klempíř, E. Kurča, M. Minár, J. Necpál, I. Rektorová, J. Roth, E. Růžička, M. škorvánek, P. Valkovič. Acute polyneuropathy in patients with Parkinson’s disease treated with LCIG [abstract]. Mov Disord. 2022; 37 (suppl 2). https://www.mdsabstracts.org/abstract/acute-polyneuropathy-in-patients-with-parkinsons-disease-treated-with-lcig/. Accessed June 14, 2025.« Back to 2022 International Congress
MDS Abstracts - https://www.mdsabstracts.org/abstract/acute-polyneuropathy-in-patients-with-parkinsons-disease-treated-with-lcig/