Objective: To evaluate whether patients affected by Parkinson’s disease (PD) under levodopa/carbidopa intestinal gel (LCIG) therapy have alterations in sensory symptoms and signs and/or painful syndrome.

Background: Small nerve fibers neuropathy (SFN) causing pain or autonomic symptoms has been reported in patients affected by advanced PD. A possible role of LCIG infusion is under investigation and is debated in the literature. It is also unclear which are the clinical features related to SFN in PD.

Methods: We investigated sensory symptoms and signs and pain perception in a consecutive series of patients with advanced PD under monotherapy with jejunal levodopa for at least six months and in a consecutive series of PD patients under treatment with oral levodopa, matched for age at onset, disease duration and levodopa equivalent daily dose. Patients who presented relevant painful OFF-period and patients affected by any medical illness which can be associated to neuropathy were excluded. Each patient was evaluated by the INCAT Sensory Sum Score (ISS), the ID-pain score, the DN4 score and the neuropathic pain survey (NPSI).

Results: We investigated 11 patients under LCGI and 13 patients under oral levodopa treatment. The overall LEDD was of 1220.5 ±265.3 in the LCGI group and 1084.2 ±813.8 in the oral levodopa group. LCGI group shows higher score of ID-pain (2.54 ±1.57 in the LCGI group and 1.30 ±1.25 in the oral levodopa group, p<0.05) and DN4 (3.90 ±2.30 in the LCGI group and 1.92 ±2.06 in the oral levodopa group, p<0.05). Moreover neuropathic pain was detected in 6 patients in the LCGI group and in 2 patients in the oral levodopa group (p<0.05).

Conclusions: Increased neuropathic pain symptoms and sensory signs are detected in PD patients under LCIG infusion. These findings could be related to small nerve fibers neuropathy, as described in a previous study (1). We suggest to evaluate PD patients under LCGI in the chronic follow-up in order to detect early a possible SFN.

References: 1) Devigili G, Rinaldo S, Lettieri C, Eleopra R. Levodopa/carbidopa intestinal gel therapy for advanced Parkinson Disease: AN early toxic effect for small nerve fibers? Muscle Nerve. 2016 Nov;54(5):970-972.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/sensory-signs-and-neuropathic-pain-in-advanced-parkinsons-disease-under-levodopa-treatment/