Devos David
Department of Neurology, EA2683 IFR114 IMPRT, Hôpital R. Salengro, CHU Lille, France.
Mov Disord. 2009 May 15;24(7):993-1000. doi: 10.1002/mds.22450.
The studies of duodenal infusion of a levodopa on small groups of parkinsonian patients have reported beneficial effects on motor complications. However, little is known about the patient profile and indications for duodenal levodopa infusion. The purpose of this study is to exhaustively investigate the clinical characteristics of the population and indication, efficacy and tolerability of duodenal levodopa infusion in natural care settings. Of the 102 patients treated with duodenal levodopa infusion since 2003, 91 were enrolled in a multicentre retrospective study. The mean age was 72.7 years, with average disease duration of 17 years. Patients were at advanced stage: 91% had gait disorders, 65% had visual hallucinations, and 50% were demented (MMSE: 23). Duodenal levodopa infusion was the last line of treatment for motor complications in 98% of the patients, due to failure of or contraindication for apomorphine pump and neurosurgical treatments. Long-term treatment was observed by 73% of the population. Of these, >90% reported an improvement in motor fluctuations, quality of life, and autonomy. There were few severe adverse events. Technical problems were commonplace. Duodenal levodopa infusion seems to be an effective last-line therapy for motor complications in Parkinson's disease. Hence, technical improvements and earlier introduction should be considered.
对一小群帕金森病患者进行十二指肠左旋多巴输注的研究报告称，该方法对运动并发症有有益效果。然而，关于十二指肠左旋多巴输注的患者特征和适应症知之甚少。本研究的目的是全面调查在自然护理环境中接受十二指肠左旋多巴输注的人群的临床特征、适应症、疗效和耐受性。自2003年以来接受十二指肠左旋多巴输注治疗的102例患者中，91例被纳入一项多中心回顾性研究。平均年龄为72.7岁，平均病程为17年。患者处于晚期：91%有步态障碍，65%有视幻觉，50%有痴呆（简易精神状态检查表：23）。98%的患者因阿扑吗啡泵和神经外科治疗失败或有禁忌证，将十二指肠左旋多巴输注作为运动并发症的最后一线治疗方法。73%的患者接受了长期治疗。其中，>90%的患者报告运动波动、生活质量和自主能力有所改善。严重不良事件很少。技术问题很常见。十二指肠左旋多巴输注似乎是帕金森病运动并发症的一种有效的最后一线治疗方法。因此，应考虑技术改进和更早引入该治疗方法。
