Movement Disorders Unit, Department of Neurology, Hospital Clínico San Carlos, C/Profesor Martín Lagos s/n, 28040, Madrid, Spain.
Department of Neurology, University Hospital 12 de Octubre, Madrid, Spain.
J Neurol. 2018 Jun;265(6):1279-1287. doi: 10.1007/s00415-018-8803-1. Epub 2018 Mar 20.
Impulse control behaviors are a frequent comorbidity for patients with Parkinson's disease (PD). The objective of the present study was to evaluate the effectiveness levodopa-carbidopa intestinal gel (LCIG) therapy on impulse control disorders (ICDs) in patients with advanced PD. We conducted a multicenter, observational, and prospective (6 months follow-up) study that included consecutive PD patients assigned to LCIG through routine medical practice. Patients completed visits at baseline, 1, 3, and 6 months after percutaneous endoscopic gastrostomy procedure. The following outcomes were evaluated: presence and severity of ICDs and other neuropsychiatric disorders, sleep disturbances, patients' quality of life, and caregivers' burden. Sixty-two patients were included at baseline: mean age 72.2 years (SD ± 7.0), 42% women. Median duration of PD symptoms was 13.5 years (IQR 5.5-21.5) and median time with motor fluctuations was 5.0 years (IQR 1.0-9.0). Treatment with LCIG infusion was associated with progressive and significant improvements in ICDs symptoms over the study period (64.4% reduction in the Questionnaire for Impulsive-Compulsive Disorders in Parkinson's disease-Rating Scale score). Psychotic and other neuropsychiatric symptoms were also significantly reduced, and patients' sleep quality and psychosocial function improved. Caregivers' burden remained unchanged. There was a significant improvement in the daily "Off" time [7.4 h (SD ± 4.0) vs 1.5 h (SD ± 1.8); p < 0.0001] at the end of follow-up, whereas duration of dyskinesias was not affected. ICDs significantly improved after 6-month LCIG treatment in a group of PD patients with mild-to-moderate neuropsychiatric disturbances.
冲动控制行为是帕金森病（PD）患者的常见合并症。本研究的目的是评估左旋多巴-卡比多巴肠凝胶（LCIG）治疗对晚期 PD 患者冲动控制障碍（ICD）的疗效。我们进行了一项多中心、观察性、前瞻性（6 个月随访）研究，纳入了通过常规医疗实践被分配到 LCIG 的连续 PD 患者。患者在经皮内镜胃造口术（PEG）后基线、1、3 和 6 个月时进行就诊。评估了以下结果：ICD 和其他神经精神障碍、睡眠障碍、患者生活质量和照顾者负担的存在和严重程度。基线时有 62 名患者入组：平均年龄 72.2 岁（标准差 ± 7.0），42%为女性。PD 症状持续时间中位数为 13.5 年（五分位间距 [IQR] 5.5-21.5），有运动波动的时间中位数为 5.0 年（IQR 1.0-9.0）。LCIG 输注治疗与研究期间 ICD 症状的逐渐显著改善相关（帕金森病冲动-强迫障碍问卷评定量表评分降低 64.4%）。精神病和其他神经精神症状也显著减少，患者的睡眠质量和心理社会功能得到改善。照顾者的负担保持不变。在随访结束时，“关期”（Off）时间明显改善[7.4 小时（标准差 ± 4.0）比 1.5 小时（标准差 ± 1.8）；p<0.0001]，而运动障碍持续时间不受影响。在一组有轻度至中度神经精神障碍的 PD 患者中，LCIG 治疗 6 个月后 ICD 显著改善。
