Intrajejunal levodopa infusion in Parkinson's disease: A pilot multicenter study of effects on nonmotor symptoms and quality of life
Identifieur interne : 000952 ( Main/Corpus ); précédent : 000951; suivant : 000953Intrajejunal levodopa infusion in Parkinson's disease: A pilot multicenter study of effects on nonmotor symptoms and quality of life
Auteurs : Holger Honig ; Angelo Antonini ; Pablo Martinez-Martin ; Ian Forgacs ; Guy C. Faye ; Thomas Fox ; Karen Fox ; Francesca Mancini ; Margherita Canesi ; Per Odin ; K. Ray ChaudhuriSource :
- Movement Disorders [ 0885-3185 ] ; 2009-07-30.
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- KwdEn :
Abstract
Switching from oral medications to continuous infusion of levodopa/carbidopa gel reduces motor complications in advanced Parkinson's disease (PD), but effects on nonmotor symptoms (NMSs) are unknown. In this prospective open‐label observational study, we report the effects of intrajejunal levodopa/carbidopa gel infusion on NMS in PD based on standard assessments utilizing the nonmotor symptoms scale (NMSS) along with the unified Parkinson's disease rating scale (UPDRS 3 motor and 4 complications) and quality of life (QoL) using the Parkinson's disease questionnaire (PDQ‐8). Twenty‐two advanced PD patients (mean age 58.6 years, duration of disease 15.3 years) were followed for 6 months. A statistically significant beneficial effect was shown in six of the nine domains of the NMSS: cardiovascular, sleep/fatigue, attention/memory, gastrointestinal, urinary, and miscellaneous (including pain and dribbling) and for the total score of this scale (NMSST) paralleling improvement of motor symptoms (UPDRS 3 motor and 4 complications in “best on” state) and dyskinesias/motor fluctuations. In addition, significant improvements were found using the Parkinson's disease sleep scale (PDSS) and the PDQ‐8 (QoL). The improvement in PDQ‐8 scores correlated highly significantly with the changes in NMSST, whereas a moderately strong correlation was observed with UPDRS changes. This is the first demonstration that a levodopa‐based continuous dopaminergic stimulation is beneficial for NMS and health‐related quality of life in PD in addition to the reduction of motor fluctuations and dyskinesias. © 2009 Movement Disorder Society
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DOI: 10.1002/mds.22596
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In this prospective open‐label observational study, we report the effects of intrajejunal levodopa/carbidopa gel infusion on NMS in PD based on standard assessments utilizing the nonmotor symptoms scale (NMSS) along with the unified Parkinson's disease rating scale (UPDRS 3 motor and 4 complications) and quality of life (QoL) using the Parkinson's disease questionnaire (PDQ‐8). Twenty‐two advanced PD patients (mean age 58.6 years, duration of disease 15.3 years) were followed for 6 months. A statistically significant beneficial effect was shown in six of the nine domains of the NMSS: cardiovascular, sleep/fatigue, attention/memory, gastrointestinal, urinary, and miscellaneous (including pain and dribbling) and for the total score of this scale (NMSST) paralleling improvement of motor symptoms (UPDRS 3 motor and 4 complications in “best on” state) and dyskinesias/motor fluctuations. In addition, significant improvements were found using the Parkinson's disease sleep scale (PDSS) and the PDQ‐8 (QoL). The improvement in PDQ‐8 scores correlated highly significantly with the changes in NMSST, whereas a moderately strong correlation was observed with UPDRS changes. This is the first demonstration that a levodopa‐based continuous dopaminergic stimulation is beneficial for NMS and health‐related quality of life in PD in addition to the reduction of motor fluctuations and dyskinesias. © 2009 Movement Disorder Society</div></front></TEI><istex><corpusName>wiley</corpusName><author><json:item><name>Holger Honig MD</name><affiliations><json:string>Department of Neurology, Central Hospital, Bremerhaven, Germany</json:string></affiliations></json:item><json:item><name>Angelo Antonini MD</name><affiliations><json:string>Parkinson Institute, ICP, Hospital San Pio X, Milan, Italy</json:string></affiliations></json:item><json:item><name>Pablo Martinez‐Martin MD</name><affiliations><json:string>Area of Applied Epidemiology, National Center for Epidemiology and CIBERNED, Carlos III Institute of Health, Madrid, Spain</json:string></affiliations></json:item><json:item><name>Ian Forgacs FRCP</name><affiliations><json:string>National Parkinson Foundation Centre of Excellence, King's College and Institute of Psychiatry, London, United Kingdom</json:string></affiliations></json:item><json:item><name>Guy C. Faye FRCP</name><affiliations><json:string>National Parkinson Foundation Centre of Excellence, King's College and Institute of Psychiatry, London, United Kingdom</json:string></affiliations></json:item><json:item><name>Thomas Fox MD</name><affiliations><json:string>Department of Neurology, Central Hospital, Bremerhaven, Germany</json:string></affiliations></json:item><json:item><name>Karen Fox MD</name><affiliations><json:string>Department of Neurology, Central Hospital, Bremerhaven, Germany</json:string></affiliations></json:item><json:item><name>Francesca Mancini MD</name><affiliations><json:string>Parkinson Institute, ICP, Hospital San Pio X, Milan, Italy</json:string></affiliations></json:item><json:item><name>Margherita Canesi MD</name><affiliations><json:string>Parkinson Institute, ICP, Hospital San Pio X, Milan, Italy</json:string></affiliations></json:item><json:item><name>Per Odin MD, PhD</name><affiliations><json:string>Department of Neurology, Central Hospital, Bremerhaven, Germany</json:string></affiliations></json:item><json:item><name>K. Ray Chaudhuri MD, FRCP, DSc</name><affiliations><json:string>National Parkinson Foundation Centre of Excellence, King's College and Institute of Psychiatry, London, United Kingdom</json:string></affiliations></json:item></author><subject><json:item><lang><json:string>eng</json:string></lang><value>Parkinson's disease</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>nonmotor</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>quality of life</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>duodenum</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>infusion</value></json:item></subject><articleId><json:string>MDS22596</json:string></articleId><language><json:string>eng</json:string></language><abstract>Switching from oral medications to continuous infusion of levodopa/carbidopa gel reduces motor complications in advanced Parkinson's disease (PD), but effects on nonmotor symptoms (NMSs) are unknown. In this prospective open‐label observational study, we report the effects of intrajejunal levodopa/carbidopa gel infusion on NMS in PD based on standard assessments utilizing the nonmotor symptoms scale (NMSS) along with the unified Parkinson's disease rating scale (UPDRS 3 motor and 4 complications) and quality of life (QoL) using the Parkinson's disease questionnaire (PDQ‐8). Twenty‐two advanced PD patients (mean age 58.6 years, duration of disease 15.3 years) were followed for 6 months. A statistically significant beneficial effect was shown in six of the nine domains of the NMSS: cardiovascular, sleep/fatigue, attention/memory, gastrointestinal, urinary, and miscellaneous (including pain and dribbling) and for the total score of this scale (NMSST) paralleling improvement of motor symptoms (UPDRS 3 motor and 4 complications in “best on” state) and dyskinesias/motor fluctuations. In addition, significant improvements were found using the Parkinson's disease sleep scale (PDSS) and the PDQ‐8 (QoL). The improvement in PDQ‐8 scores correlated highly significantly with the changes in NMSST, whereas a moderately strong correlation was observed with UPDRS changes. This is the first demonstration that a levodopa‐based continuous dopaminergic stimulation is beneficial for NMS and health‐related quality of life in PD in addition to the reduction of motor fluctuations and dyskinesias. © 2009 Movement Disorder Society</abstract><qualityIndicators><score>6.733</score><pdfVersion>1.3</pdfVersion><pdfPageSize>612 x 810 pts</pdfPageSize><refBibsNative>true</refBibsNative><keywordCount>5</keywordCount><abstractCharCount>1631</abstractCharCount><pdfWordCount>3985</pdfWordCount><pdfCharCount>27383</pdfCharCount><pdfPageCount>7</pdfPageCount><abstractWordCount>229</abstractWordCount></qualityIndicators><title>Intrajejunal levodopa infusion in Parkinson's disease: A pilot multicenter study of effects on nonmotor symptoms and quality of 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life</title></titleStmt><publicationStmt><authority>ISTEX</authority><publisher>Wiley Subscription Services, Inc., A Wiley Company</publisher><pubPlace>Hoboken</pubPlace><availability><p>WILEY</p></availability><date>2009</date></publicationStmt><notesStmt><note type="content">*Potential conflict of interest: None reported.</note><note>Boehringer‐Ingelheim</note><note>Solvay</note><note>Novartis</note><note>GSK</note><note>UCB pharma</note><note>Brittannia Pharmaceuticals</note><note>Cephalon</note><note>GlaxoSmithKline</note><note>Orion Pharma</note></notesStmt><sourceDesc><biblStruct type="inbook"><analytic><title level="a" type="main" xml:lang="en">Intrajejunal levodopa infusion in Parkinson's disease: A pilot multicenter study of effects on nonmotor symptoms and quality of life</title><author><persName><forename type="first">Holger</forename><surname>Honig</surname></persName><roleName type="degree">MD</roleName><affiliation>Department of Neurology, Central Hospital, Bremerhaven, Germany</affiliation></author><author><persName><forename type="first">Angelo</forename><surname>Antonini</surname></persName><roleName type="degree">MD</roleName><affiliation>Parkinson Institute, ICP, Hospital San Pio X, Milan, Italy</affiliation></author><author><persName><forename type="first">Pablo</forename><surname>Martinez‐Martin</surname></persName><roleName type="degree">MD</roleName><affiliation>Area of Applied Epidemiology, National Center for Epidemiology and CIBERNED, Carlos III Institute of Health, Madrid, Spain</affiliation></author><author><persName><forename type="first">Ian</forename><surname>Forgacs</surname></persName><roleName type="degree">FRCP</roleName><affiliation>National Parkinson Foundation Centre of Excellence, King's College and Institute of Psychiatry, London, United Kingdom</affiliation></author><author><persName><forename type="first">Guy C.</forename><surname>Faye</surname></persName><roleName type="degree">FRCP</roleName><affiliation>National Parkinson Foundation Centre of Excellence, King's College and Institute of Psychiatry, London, United Kingdom</affiliation></author><author><persName><forename type="first">Thomas</forename><surname>Fox</surname></persName><roleName type="degree">MD</roleName><affiliation>Department of Neurology, Central Hospital, Bremerhaven, Germany</affiliation></author><author><persName><forename type="first">Karen</forename><surname>Fox</surname></persName><roleName type="degree">MD</roleName><affiliation>Department of Neurology, Central Hospital, Bremerhaven, Germany</affiliation></author><author><persName><forename type="first">Francesca</forename><surname>Mancini</surname></persName><roleName type="degree">MD</roleName><affiliation>Parkinson Institute, ICP, Hospital San Pio X, Milan, Italy</affiliation></author><author><persName><forename type="first">Margherita</forename><surname>Canesi</surname></persName><roleName type="degree">MD</roleName><affiliation>Parkinson Institute, ICP, Hospital San Pio X, Milan, Italy</affiliation></author><author><persName><forename type="first">Per</forename><surname>Odin</surname></persName><roleName type="degree">MD, PhD</roleName><affiliation>Department of Neurology, Central Hospital, Bremerhaven, Germany</affiliation></author><author><persName><forename type="first">K. Ray</forename><surname>Chaudhuri</surname></persName><roleName type="degree">MD, FRCP, DSc</roleName><note type="correspondence"><p>Correspondence: National Parkinson Foundation Centre of Excellence, 9th Floor Ruskin Wing, King's College Hospital, Denmark Hill, London SE5 9RS, United Kingdom</p></note><affiliation>National Parkinson Foundation Centre of Excellence, King's College and Institute of Psychiatry, London, United Kingdom</affiliation></author></analytic><monogr><title level="j">Movement Disorders</title><title level="j" type="sub">Official Journal of the Movement Disorder Society</title><title level="j" type="abbrev">Mov. Disord.</title><idno type="pISSN">0885-3185</idno><idno type="eISSN">1531-8257</idno><idno type="DOI">10.1002/(ISSN)1531-8257</idno><imprint><publisher>Wiley Subscription Services, Inc., A Wiley Company</publisher><pubPlace>Hoboken</pubPlace><date type="published" when="2009-07-30"></date><biblScope unit="volume">24</biblScope><biblScope unit="issue">10</biblScope><biblScope unit="page" from="1468">1468</biblScope><biblScope unit="page" to="1474">1474</biblScope></imprint></monogr><idno type="istex">91DBE24E89365179641D45D34173F1AC6D7BD2E5</idno><idno type="DOI">10.1002/mds.22596</idno><idno type="ArticleID">MDS22596</idno></biblStruct></sourceDesc></fileDesc><profileDesc><creation><date>2009</date></creation><langUsage><language ident="en">en</language></langUsage><abstract xml:lang="en"><p>Switching from oral medications to continuous infusion of levodopa/carbidopa gel reduces motor complications in advanced Parkinson's disease (PD), but effects on nonmotor symptoms (NMSs) are unknown. In this prospective open‐label observational study, we report the effects of intrajejunal levodopa/carbidopa gel infusion on NMS in PD based on standard assessments utilizing the nonmotor symptoms scale (NMSS) along with the unified Parkinson's disease rating scale (UPDRS 3 motor and 4 complications) and quality of life (QoL) using the Parkinson's disease questionnaire (PDQ‐8). Twenty‐two advanced PD patients (mean age 58.6 years, duration of disease 15.3 years) were followed for 6 months. A statistically significant beneficial effect was shown in six of the nine domains of the NMSS: cardiovascular, sleep/fatigue, attention/memory, gastrointestinal, urinary, and miscellaneous (including pain and dribbling) and for the total score of this scale (NMSST) paralleling improvement of motor symptoms (UPDRS 3 motor and 4 complications in “best on” state) and dyskinesias/motor fluctuations. In addition, significant improvements were found using the Parkinson's disease sleep scale (PDSS) and the PDQ‐8 (QoL). The improvement in PDQ‐8 scores correlated highly significantly with the changes in NMSST, whereas a moderately strong correlation was observed with UPDRS changes. This is the first demonstration that a levodopa‐based continuous dopaminergic stimulation is beneficial for NMS and health‐related quality of life in PD in addition to the reduction of motor fluctuations and dyskinesias. © 2009 Movement Disorder Society</p></abstract><textClass xml:lang="en"><keywords scheme="keyword"><list><head>Keywords</head><item><term>Parkinson's disease</term></item><item><term>nonmotor</term></item><item><term>quality of life</term></item><item><term>duodenum</term></item><item><term>infusion</term></item></list></keywords></textClass><textClass><keywords scheme="Journal Subject"><list><head>article category</head><item><term>Research Article</term></item></list></keywords></textClass></profileDesc><revisionDesc><change when="2009-01-07">Received</change><change when="2009-03-17">Registration</change><change when="2009-07-30">Published</change></revisionDesc></teiHeader></istex:fulltextTEI><json:item><original>false</original><mimetype>text/plain</mimetype><extension>txt</extension><uri>https://api.istex.fr/document/91DBE24E89365179641D45D34173F1AC6D7BD2E5/fulltext/txt</uri></json:item></fulltext><metadata><istex:metadataXml wicri:clean="Wiley, elements deleted: body"><istex:xmlDeclaration>version="1.0" encoding="UTF-8" standalone="yes"</istex:xmlDeclaration><istex:document><component version="2.0" type="serialArticle" xml:lang="en"><header><publicationMeta level="product"><publisherInfo><publisherName>Wiley Subscription Services, Inc., A Wiley Company</publisherName><publisherLoc>Hoboken</publisherLoc></publisherInfo><doi registered="yes">10.1002/(ISSN)1531-8257</doi><issn type="print">0885-3185</issn><issn type="electronic">1531-8257</issn><idGroup><id type="product" value="MDS"></id></idGroup><titleGroup><title type="main" xml:lang="en" sort="MOVEMENT DISORDERS">Movement Disorders</title><title type="subtitle">Official Journal of the Movement Disorder Society</title><title type="short">Mov. Disord.</title></titleGroup></publicationMeta><publicationMeta level="part" position="100"><doi origin="wiley" registered="yes">10.1002/mds.v24:10</doi><numberingGroup><numbering type="journalVolume" number="24">24</numbering><numbering type="journalIssue">10</numbering></numberingGroup><coverDate startDate="2009-07-30">30 July 2009</coverDate></publicationMeta><publicationMeta level="unit" type="article" position="70" status="forIssue"><doi origin="wiley" registered="yes">10.1002/mds.22596</doi><idGroup><id type="unit" value="MDS22596"></id></idGroup><countGroup><count type="pageTotal" number="7"></count></countGroup><titleGroup><title type="articleCategory">Research Article</title><title type="tocHeading1">Research Articles</title></titleGroup><copyright ownership="thirdParty">Copyright © 2009 Movement Disorder Society</copyright><eventGroup><event type="manuscriptReceived" date="2009-01-07"></event><event type="manuscriptRevised" date="2009-02-16"></event><event type="manuscriptAccepted" date="2009-03-17"></event><event type="publishedOnlineEarlyUnpaginated" date="2009-05-07"></event><event type="firstOnline" date="2009-05-07"></event><event type="publishedOnlineFinalForm" date="2009-07-24"></event><event type="xmlConverted" agent="Converter:JWSART34_TO_WML3G version:2.3.2 mode:FullText source:FullText result:FullText" date="2010-03-09"></event><event type="xmlConverted" agent="Converter:WILEY_ML3G_TO_WILEY_ML3GV2 version:3.8.8" date="2014-02-02"></event><event type="xmlConverted" agent="Converter:WML3G_To_WML3G version:4.1.7 mode:FullText,remove_FC" date="2014-10-31"></event></eventGroup><numberingGroup><numbering type="pageFirst">1468</numbering><numbering type="pageLast">1474</numbering></numberingGroup><correspondenceTo>National Parkinson Foundation Centre of Excellence, 9th Floor Ruskin Wing, King's College Hospital, Denmark Hill, London SE5 9RS, United Kingdom</correspondenceTo><linkGroup><link type="toTypesetVersion" href="file:MDS.MDS22596.pdf"></link></linkGroup></publicationMeta><contentMeta><countGroup><count type="figureTotal" number="1"></count><count type="tableTotal" number="2"></count><count type="referenceTotal" number="36"></count><count type="wordTotal" number="5522"></count></countGroup><titleGroup><title type="main" xml:lang="en">Intrajejunal levodopa infusion in Parkinson's disease: A pilot multicenter study of effects on nonmotor symptoms and quality of life<link href="#fn8"></link></title><title type="short" xml:lang="en">Levodopa Infusion and Nonmotor PD Symptoms</title></titleGroup><creators><creator xml:id="au1" creatorRole="author" affiliationRef="#af1"><personName><givenNames>Holger</givenNames><familyName>Honig</familyName><degrees>MD</degrees></personName></creator><creator xml:id="au2" creatorRole="author" affiliationRef="#af2"><personName><givenNames>Angelo</givenNames><familyName>Antonini</familyName><degrees>MD</degrees></personName></creator><creator xml:id="au3" creatorRole="author" affiliationRef="#af3"><personName><givenNames>Pablo</givenNames><familyName>Martinez‐Martin</familyName><degrees>MD</degrees></personName></creator><creator xml:id="au4" creatorRole="author" affiliationRef="#af4"><personName><givenNames>Ian</givenNames><familyName>Forgacs</familyName><degrees>FRCP</degrees></personName></creator><creator xml:id="au5" creatorRole="author" affiliationRef="#af4"><personName><givenNames>Guy C.</givenNames><familyName>Faye</familyName><degrees>FRCP</degrees></personName></creator><creator xml:id="au6" creatorRole="author" affiliationRef="#af1"><personName><givenNames>Thomas</givenNames><familyName>Fox</familyName><degrees>MD</degrees></personName></creator><creator xml:id="au7" creatorRole="author" affiliationRef="#af1"><personName><givenNames>Karen</givenNames><familyName>Fox</familyName><degrees>MD</degrees></personName></creator><creator xml:id="au8" creatorRole="author" affiliationRef="#af2"><personName><givenNames>Francesca</givenNames><familyName>Mancini</familyName><degrees>MD</degrees></personName></creator><creator xml:id="au9" creatorRole="author" affiliationRef="#af2"><personName><givenNames>Margherita</givenNames><familyName>Canesi</familyName><degrees>MD</degrees></personName></creator><creator xml:id="au10" creatorRole="author" affiliationRef="#af1"><personName><givenNames>Per</givenNames><familyName>Odin</familyName><degrees>MD, PhD</degrees></personName></creator><creator xml:id="au11" creatorRole="author" affiliationRef="#af4" corresponding="yes"><personName><givenNames>K. Ray</givenNames><familyName>Chaudhuri</familyName><degrees>MD, FRCP, DSc</degrees></personName><contactDetails><email>ray.chaudhuri@uhl.nhs.uk</email></contactDetails></creator></creators><affiliationGroup><affiliation xml:id="af1" countryCode="DE" type="organization"><unparsedAffiliation>Department of Neurology, Central Hospital, Bremerhaven, Germany</unparsedAffiliation></affiliation><affiliation xml:id="af2" countryCode="IT" type="organization"><unparsedAffiliation>Parkinson Institute, ICP, Hospital San Pio X, Milan, Italy</unparsedAffiliation></affiliation><affiliation xml:id="af3" countryCode="ES" type="organization"><unparsedAffiliation>Area of Applied Epidemiology, National Center for Epidemiology and CIBERNED, Carlos III Institute of Health, Madrid, Spain</unparsedAffiliation></affiliation><affiliation xml:id="af4" countryCode="GB" type="organization"><unparsedAffiliation>National Parkinson Foundation Centre of Excellence, King's College and Institute of Psychiatry, London, United Kingdom</unparsedAffiliation></affiliation></affiliationGroup><keywordGroup xml:lang="en" type="author"><keyword xml:id="kwd1">Parkinson's disease</keyword><keyword xml:id="kwd2">nonmotor</keyword><keyword xml:id="kwd3">quality of life</keyword><keyword xml:id="kwd4">duodenum</keyword><keyword xml:id="kwd5">infusion</keyword></keywordGroup><fundingInfo><fundingAgency>Boehringer‐Ingelheim</fundingAgency></fundingInfo><fundingInfo><fundingAgency>Solvay</fundingAgency></fundingInfo><fundingInfo><fundingAgency>Novartis</fundingAgency></fundingInfo><fundingInfo><fundingAgency>GSK</fundingAgency></fundingInfo><fundingInfo><fundingAgency>UCB pharma</fundingAgency></fundingInfo><fundingInfo><fundingAgency>Brittannia Pharmaceuticals</fundingAgency></fundingInfo><fundingInfo><fundingAgency>Cephalon</fundingAgency></fundingInfo><fundingInfo><fundingAgency>GlaxoSmithKline</fundingAgency></fundingInfo><fundingInfo><fundingAgency>Orion Pharma</fundingAgency></fundingInfo><abstractGroup><abstract type="main" xml:lang="en"><title type="main">Abstract</title><p>Switching from oral medications to continuous infusion of levodopa/carbidopa gel reduces motor complications in advanced Parkinson's disease (PD), but effects on nonmotor symptoms (NMSs) are unknown. In this prospective open‐label observational study, we report the effects of intrajejunal levodopa/carbidopa gel infusion on NMS in PD based on standard assessments utilizing the nonmotor symptoms scale (NMSS) along with the unified Parkinson's disease rating scale (UPDRS 3 motor and 4 complications) and quality of life (QoL) using the Parkinson's disease questionnaire (PDQ‐8). Twenty‐two advanced PD patients (mean age 58.6 years, duration of disease 15.3 years) were followed for 6 months. A statistically significant beneficial effect was shown in six of the nine domains of the NMSS: cardiovascular, sleep/fatigue, attention/memory, gastrointestinal, urinary, and miscellaneous (including pain and dribbling) and for the total score of this scale (NMSST) paralleling improvement of motor symptoms (UPDRS 3 motor and 4 complications in “best on” state) and dyskinesias/motor fluctuations. In addition, significant improvements were found using the Parkinson's disease sleep scale (PDSS) and the PDQ‐8 (QoL). The improvement in PDQ‐8 scores correlated highly significantly with the changes in NMSST, whereas a moderately strong correlation was observed with UPDRS changes. This is the first demonstration that a levodopa‐based continuous dopaminergic stimulation is beneficial for NMS and health‐related quality of life in PD in addition to the reduction of motor fluctuations and dyskinesias. © 2009 Movement Disorder Society</p></abstract></abstractGroup></contentMeta><noteGroup><note xml:id="fn8"><p>Potential conflict of interest: None reported.</p></note></noteGroup></header></component></istex:document></istex:metadataXml><mods version="3.6"><titleInfo lang="en"><title>Intrajejunal levodopa infusion in Parkinson's disease: A pilot multicenter study of effects on nonmotor symptoms and quality of life</title></titleInfo><titleInfo type="abbreviated" lang="en"><title>Levodopa Infusion and Nonmotor PD Symptoms</title></titleInfo><titleInfo type="alternative" contentType="CDATA" lang="en"><title>Intrajejunal levodopa infusion in Parkinson's disease: A pilot multicenter study of effects on nonmotor symptoms and quality of life</title></titleInfo><name type="personal"><namePart type="given">Holger</namePart><namePart type="family">Honig</namePart><namePart type="termsOfAddress">MD</namePart><affiliation>Department of Neurology, Central Hospital, Bremerhaven, Germany</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Angelo</namePart><namePart type="family">Antonini</namePart><namePart type="termsOfAddress">MD</namePart><affiliation>Parkinson Institute, ICP, Hospital San Pio X, Milan, Italy</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Pablo</namePart><namePart type="family">Martinez‐Martin</namePart><namePart type="termsOfAddress">MD</namePart><affiliation>Area of Applied Epidemiology, National Center for Epidemiology and CIBERNED, Carlos III Institute of Health, Madrid, Spain</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Ian</namePart><namePart type="family">Forgacs</namePart><namePart type="termsOfAddress">FRCP</namePart><affiliation>National Parkinson Foundation Centre of Excellence, King's College and Institute of Psychiatry, London, United Kingdom</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Guy C.</namePart><namePart type="family">Faye</namePart><namePart type="termsOfAddress">FRCP</namePart><affiliation>National Parkinson Foundation Centre of Excellence, King's College and Institute of Psychiatry, London, United Kingdom</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Thomas</namePart><namePart type="family">Fox</namePart><namePart type="termsOfAddress">MD</namePart><affiliation>Department of Neurology, Central Hospital, Bremerhaven, Germany</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Karen</namePart><namePart type="family">Fox</namePart><namePart type="termsOfAddress">MD</namePart><affiliation>Department of Neurology, Central Hospital, Bremerhaven, Germany</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Francesca</namePart><namePart type="family">Mancini</namePart><namePart type="termsOfAddress">MD</namePart><affiliation>Parkinson Institute, ICP, Hospital San Pio X, Milan, Italy</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Margherita</namePart><namePart type="family">Canesi</namePart><namePart type="termsOfAddress">MD</namePart><affiliation>Parkinson Institute, ICP, Hospital San Pio X, Milan, Italy</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Per</namePart><namePart type="family">Odin</namePart><namePart type="termsOfAddress">MD, PhD</namePart><affiliation>Department of Neurology, Central Hospital, Bremerhaven, Germany</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">K. Ray</namePart><namePart type="family">Chaudhuri</namePart><namePart type="termsOfAddress">MD, FRCP, DSc</namePart><affiliation>National Parkinson Foundation Centre of Excellence, King's College and Institute of Psychiatry, London, United Kingdom</affiliation><description>Correspondence: National Parkinson Foundation Centre of Excellence, 9th Floor Ruskin Wing, King's College Hospital, Denmark Hill, London SE5 9RS, United Kingdom</description><role><roleTerm type="text">author</roleTerm></role></name><typeOfResource>text</typeOfResource><genre type="article" displayLabel="article"></genre><originInfo><publisher>Wiley Subscription Services, Inc., A Wiley Company</publisher><place><placeTerm type="text">Hoboken</placeTerm></place><dateIssued encoding="w3cdtf">2009-07-30</dateIssued><dateCaptured encoding="w3cdtf">2009-01-07</dateCaptured><dateValid encoding="w3cdtf">2009-03-17</dateValid><copyrightDate encoding="w3cdtf">2009</copyrightDate></originInfo><language><languageTerm type="code" authority="rfc3066">en</languageTerm><languageTerm type="code" authority="iso639-2b">eng</languageTerm></language><physicalDescription><internetMediaType>text/html</internetMediaType><extent unit="figures">1</extent><extent unit="tables">2</extent><extent unit="references">36</extent><extent unit="words">5522</extent></physicalDescription><abstract lang="en">Switching from oral medications to continuous infusion of levodopa/carbidopa gel reduces motor complications in advanced Parkinson's disease (PD), but effects on nonmotor symptoms (NMSs) are unknown. In this prospective open‐label observational study, we report the effects of intrajejunal levodopa/carbidopa gel infusion on NMS in PD based on standard assessments utilizing the nonmotor symptoms scale (NMSS) along with the unified Parkinson's disease rating scale (UPDRS 3 motor and 4 complications) and quality of life (QoL) using the Parkinson's disease questionnaire (PDQ‐8). Twenty‐two advanced PD patients (mean age 58.6 years, duration of disease 15.3 years) were followed for 6 months. A statistically significant beneficial effect was shown in six of the nine domains of the NMSS: cardiovascular, sleep/fatigue, attention/memory, gastrointestinal, urinary, and miscellaneous (including pain and dribbling) and for the total score of this scale (NMSST) paralleling improvement of motor symptoms (UPDRS 3 motor and 4 complications in “best on” state) and dyskinesias/motor fluctuations. In addition, significant improvements were found using the Parkinson's disease sleep scale (PDSS) and the PDQ‐8 (QoL). The improvement in PDQ‐8 scores correlated highly significantly with the changes in NMSST, whereas a moderately strong correlation was observed with UPDRS changes. This is the first demonstration that a levodopa‐based continuous dopaminergic stimulation is beneficial for NMS and health‐related quality of life in PD in addition to the reduction of motor fluctuations and dyskinesias. © 2009 Movement Disorder Society</abstract><note type="content">*Potential conflict of interest: None reported.</note><note type="funding">Boehringer‐Ingelheim</note><note type="funding">Solvay</note><note type="funding">Novartis</note><note type="funding">GSK</note><note type="funding">UCB pharma</note><note type="funding">Brittannia Pharmaceuticals</note><note type="funding">Cephalon</note><note type="funding">GlaxoSmithKline</note><note type="funding">Orion Pharma</note><subject lang="en"><genre>Keywords</genre><topic>Parkinson's disease</topic><topic>nonmotor</topic><topic>quality of life</topic><topic>duodenum</topic><topic>infusion</topic></subject><relatedItem type="host"><titleInfo><title>Movement Disorders</title><subTitle>Official Journal of the Movement Disorder Society</subTitle></titleInfo><titleInfo type="abbreviated"><title>Mov. 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