Section of Neurology, Hospital A. Marcide, C/San Pedro Leixa s/n, 15405 Ferrol, Spain.
J Neurol. 2012 Aug;259(8):1668-72. doi: 10.1007/s00415-011-6396-z. Epub 2012 Jan 24.
Some reports have emerged describing the occurrence of Guillain-Barré syndrome and polyneuropathy related to vitamin B(12) deficiency in some patients with Parkinson's disease (PD) treated with continuous duodenal levodopa infusion. We describe five PD patients who developed axonal polyneuropathy and vitamin B(12) deficiency while on treatment with duodenal levodopa infusion, review other cases reported in the literature, discuss potential etiologic factors, and suggest a possible algorithm for the management and prevention of this complication. One case of Guillain-Barré syndrome and at least 12 cases of polyneuropathy related to vitamin B(12) deficiency have been reported in PD patients treated with duodenal levodopa infusion. Levodopa gel infusion may induce a decrease in vitamin B(12) levels, leading to peripheral neuropathy. Additional pathogenetic mechanisms include alterations related to the metabolism of L: -dopa, abnormal L: -dopa absorption, and direct neurotoxicity of L: -dopa at high doses. Vitamin B(12) supplementation may need to be considered in PD patients on duodenal levodopa infusion therapy. Vitamin B(12) deficiency in patients on duodenal levodopa infusion therapy may be more frequent than the published data suggest. We must be alert.
一些报告描述了一些接受连续十二指肠左旋多巴输注治疗的帕金森病 (PD) 患者出现吉兰-巴雷综合征和与维生素 B(12) 缺乏相关的多发性神经病。我们描述了 5 例 PD 患者在接受十二指肠左旋多巴输注治疗时发生轴索性多发性神经病和维生素 B(12) 缺乏症，回顾了文献中报道的其他病例，讨论了潜在的病因因素，并提出了这种并发症的管理和预防的可能方案。在接受十二指肠左旋多巴输注治疗的 PD 患者中，已报告了 1 例吉兰-巴雷综合征和至少 12 例与维生素 B(12) 缺乏相关的多发性神经病。左旋多巴凝胶输注可能会导致维生素 B(12) 水平降低，从而导致周围神经病。其他发病机制包括与 L: -多巴代谢相关的改变、异常的 L: -多巴吸收以及高剂量 L: -多巴的直接神经毒性。在接受十二指肠左旋多巴输注治疗的 PD 患者中，可能需要考虑补充维生素 B(12)。接受十二指肠左旋多巴输注治疗的患者中维生素 B(12) 缺乏症可能比已发表的数据更为常见。我们必须保持警惕。
