Antonini A, Mancini F, Canesi M, Zangaglia R, Isaias I U, Manfredi L, Pacchetti C, Zibetti M, Natuzzi F, Lopiano L, Nappi G, Pezzoli G
Parkinson Institute, Istituti Clinici di Perfezionamento, Milano, Italia.
Neurodegener Dis. 2008;5(3-4):244-6. doi: 10.1159/000113714. Epub 2008 Mar 6.
A significant percentage of patients with Parkinson's disease (PD) continue to experience motor fluctuations and dyskinesias despite the association of dopamine agonists and levodopa with COMT or MAO-B inhibitors. The use of apomorphine infusion is limited by compliance while deep brain stimulation is feasible only for a small number of patients mostly because of age constraints.
To assess prospectively the effectiveness of duodenal levodopa infusion on quality of life as well as motor features in patients with advanced PD. In all but 1 case levodopa infusion was stopped at nighttime.
We report the outcome of 22 PD patients, followed for up to 2 years, who were on continuous duodenal levodopa/carbidopa infusion through percutaneous endoscopic gastrostomy.
We found a significant reduction in 'off' period duration as well as dyskinesia severity (Unified Parkinson's Disease Rating Scale part IV, items 33 and 39). There was significant improvement in the 39-item Parkinson's Disease Quality of Life Questionnaire as well as in the Unified Parkinson's Disease Rating Scale part II up to the 2-year follow-up. Five patients withdrew: 2 for poor compliance and 3 for adverse events (1 was related to percutaneous endoscopic gastrostomy).
These results demonstrate significant clinical improvements in quality of life and activities of daily living consistent with the occurrence of a satisfactory therapeutic response and a reduction in dyskinesia severity.
尽管多巴胺激动剂以及左旋多巴与儿茶酚-O-甲基转移酶（COMT）或单胺氧化酶-B（MAO-B）抑制剂联合使用，但仍有相当比例的帕金森病（PD）患者持续出现运动波动和异动症。阿扑吗啡输注的应用受依从性限制，而深部脑刺激仅对少数患者可行，主要是因为年龄限制。
前瞻性评估十二指肠左旋多巴输注对晚期PD患者生活质量以及运动特征的有效性。除1例患者外，所有患者夜间均停止左旋多巴输注。
我们报告了22例接受经皮内镜下胃造口术持续十二指肠左旋多巴/卡比多巴输注的PD患者的随访结果，随访时间长达2年。
我们发现“关”期时长以及异动症严重程度（统一帕金森病评定量表第四部分，项目33和39）显著降低。在长达2年的随访中，帕金森病生活质量问卷39项条目以及统一帕金森病评定量表第二部分均有显著改善。5例患者退出研究：2例因依从性差，3例因不良事件（1例与经皮内镜下胃造口术有关）。
这些结果表明，生活质量和日常生活活动有显著临床改善，这与出现满意的治疗反应以及异动症严重程度降低相一致。
