RESEARCH ARTICLE


Practical Guidance on How to Handle Levodopa/Carbidopa Intestinal Gel Therapy of Advanced PD in a Movement Disorder Clinic



Stephen Wørlich Pedersen*, Jesper Clausen, Mie Manon Gregerslund
Movement Disorder Clinic, Department of Neurology, Copenhagen University Hospital Glostrup, Denmark


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© Pedersen et al.; Licensee Bentham Open.

open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

* Address correspondence to this author at the Movement Disorder Department of Neurology Copenhagen University Hospital Glostrup, DK-2600 Glostrup, Denmark; Tel: +45 43233468; Fax: +45 38633926; E-mail: stephen.w.pedersen@regionh.dk


Abstract

Continuous dopaminergic delivery is recognized for the capacity to ameliorate symptoms in Parkinson’s disease (PD). In advanced PD the short comings of orally administered Levodopa/Carbidopa include fluctuations resulting in unstable effect and dyskinesia. Levodopa/Carbidopa intestinal gel, LCIG, (Duodopa®, Abbott Laboratories) is delivered continuously through a percutaneous endoscopic gastrostomy with the inner tube placed in the duodenum by means of a device (CADD legacy Duodopa pump (CE 0473)). The therapy implies continuous dopaminergic delivery directly to the duodenum and is therefore unaffected by gastric emptying and represents a major adjuvant in the treatment of advanced PD with significant improvement in motor and non-motor symptoms. The aim of this paper is to suggest the prerequisites for a LCIG clinic and propose a feasible set-up and lean organization of a movement disorder clinic. Secondly, the paper proposes practical handling of patients in LCIG treatment for advanced PD based on experience and initiation of LCIG treatment and follow-up in forty patients.

Keywords: Administration, advanced PD, continuous dopaminergic delivery, Duodopa, dyskinesia, fluctuations, LCIG, organization.