二级医院中晚期帕金森病患者持续左旋多巴肠内输注（Duodopa（®））的经验

[Experience with continuous levodopa enteral infusion (Duodopa(®)) in patients with advanced Parkinson's disease in a secondary level hospital].

作者信息

Santos-García D, Macías M, Llaneza M, Fuster-Sanjurjo L, Echarri-Piudo A, Belmonte S, Blanco S

机构信息

Sección de Neurología, Hospital Arquitecto Marcide, Ferrol (A Coruña), España.

出版信息

Neurologia. 2010 Nov-Dec;25(9):536-43. doi: 10.1016/j.nrl.2010.07.018. Epub 2010 Oct 8.

DOI:10.1016/j.nrl.2010.07.018

PMID:21093702

Abstract

INTRODUCTION

Continuous levodopa delivery by enteral infusion (Duodopa(®)) is an alternative to deep brain stimulation and subcutaneous apomorphine to control motor fluctuations and dyskinesias in advanced Parkinson's disease (PD). We report our experience with Duodopa(®) therapy in 11 patients with advanced PD.

METHODS

We retrospectively assessed clinical and quality of life changes in all patients with PD with severe motor fluctuations and dyskinesias who started continuous daily levodopa duodenal infusion through percutaneous endoscopic gastrostomy from September 2006 (Duodopa(®) was approved for advanced PD treatment in Spain at that date) until April 2010 at the A. Marcide Hospital of Spain.

RESULTS

Nine patients received Duodopa(®) [62.7±10.6 (44-74) years, 63.6% male)]. Pre-Duodopa(®) clinical characteristics of patients were: disease duration 14.5±8.9 (3-34) years, oral levodopa dose 918.2±277.7 (450-1300) mg/day, and Hoehn and Yahr staging 3.7±0.5 (3-4). Nine patients are still receiving Duodopa(®). Patients improved motor fluctuations (72.7% significant improvement), dyskinesia (55.5% significant improvement), daily off-time (90.9%) and daily duration dyskinesia (66.6%) after total infusion time of 170.5 months (3-31). The improvement in Parkinson's Disease Quality of Life Questionnaire-39 (PDQ-39) and Schwab&England Capacity for Daily Living Scale were 38.5±19.8 and 24±12.5 respectively (P<0.05). Equivalent daily dose of levodopa (April 2010) was 1683.4±295.8 (1234-2216) mg/day.

CONCLUSIONS

Intraduodenal infusion of levodopa offers an important alternative in treating patients with advanced Parkinson disease.

摘要

引言

通过肠内输注持续给予左旋多巴（Duodopa®）是深部脑刺激和皮下注射阿扑吗啡之外的另一种选择，用于控制晚期帕金森病（PD）的运动波动和异动症。我们报告了11例晚期PD患者使用Duodopa®治疗的经验。

方法

我们回顾性评估了2006年9月（当时Duodopa®在西班牙被批准用于晚期PD治疗）至2010年4月在西班牙A. Marcide医院开始通过经皮内镜下胃造口术进行每日持续左旋多巴十二指肠输注的所有重度运动波动和异动症PD患者的临床及生活质量变化。

结果

9例患者接受了Duodopa®治疗[年龄62.7±10.6（44 - 74）岁，男性占63.6%]。患者在接受Duodopa®治疗前的临床特征为：病程14.5±8.9（3 - 34）年，口服左旋多巴剂量918.2±277.7（450 - 1300）mg/天，Hoehn和Yahr分期3.7±0.5（3 - 4）。9例患者仍在接受Duodopa®治疗。在总输注时间170.5个月（3 - 31个月）后，患者的运动波动（72.7%显著改善）、异动症（55.5%显著改善）、每日“关”期时间（90.9%）和每日异动症持续时间（66.6%）均得到改善。帕金森病生活质量问卷-39（PDQ - 39）和施瓦布&英格兰日常生活能力量表的改善分别为38.5±19.8和24±12.5（P<0.05）。2010年4月左旋多巴的等效日剂量为1683.4±295.8（1234 - 2216）mg/天。