Objective: In this study we seek to compare characteristics and complications of patients suffering from advanced Parkinson’s treated with duodenal levodopa infusion.

Background: Motor fluctuations whilst on dopaminergic therapy account for the majority of decisions to place patients on duodenal levodopa infusion. This approach has consistently yielded desirable motor outcomes in advanced PD since its introduction. However, extended follow-up is required to further define its long-term implications.

Method: We conducted an observational retrospective study on 24 patients placed on duodenal levodopa infusion between 2011 and 2022 in our center. Data regarding epidemiology, concomitant medication and therapy-derived complications were collected. Three similarly sized groups based on length of treatment were defined: 1 to 3 years of infusion (short term), 3 to 7 (long term) and 7 up to 9 (very long term). We performed descriptive and statistical analysis.

Results: No significant differences were found regarding gender (66.7%, 57.1% and 80% of men in each group, respectively), age at PD onset (mean of 57.25 years SD8.8; 56.86 SD13.2; 58.2 SD5.2) or length of PD evolution until infusion placement (mean of 15.4 years SD4.2; 15.5 SD11; 15.2 SD4.4). No differences were found on antidepressant intake (75%; 85.7%; 80%), antipsychotics (50%; 57.1%; 20%) or memory-aiding drugs (25%; 14.3%; 60%). Previous usage of apomorphine infusion (50%; 14.3%; 60%) or subthalamic nucleus stimulation (41.7%; 28.6%; 40%) was likewise similar. Pump-derived complications were evenly distributed: namely B vitamin deficiency (16.7%; 42.9%; 20%) with no associated polyneuropathy and one isolated case of buried bumper. A tendency toward signification (p=0.065) was found concerning granuloma apparition (8.3%; 42.9%; 60%), however all cases appeared in the first two years from infusion. Statistical signification was found in the case of stoma infection (8.3%; 14.3%; 60%, p=0.05), presenting a correlation with length of treatment.

Conclusion: No significant differences depending on length of treatment were found in either patient characteristics, associated comorbidity or pump-derived complications aside from stoma infection, which highlights the role of specialised nursery. Duodenal levodopa infusion represents thus a safe and effective therapy in the long term, although more extended follow-up and larger samples are required to establish further care needs.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/comparing-duodenal-levodopa-infusion-based-on-length-of-treatment-in-advanced-parkinsons/