Cruse Belinda, Morales-Briceño Hugo, Chang Florence C F, Mahant Neil, Ha Ainhi D, Kim Samuel D, Wolfe Nigel, Kwan Vu, Tsui David S, Griffith Jane M, Galea Donna, Fung Victor S C
1Movement Disorders Unit, Neurology Department, Westmead Hospital, Corner Darcy and Hawkesbury Road, Westmead, NSW 2145 Australia.
2Sydney Medical School, University of Sydney, Sydney, Australia.
NPJ Parkinsons Dis. 2018 Nov 20;4:34. doi: 10.1038/s41531-018-0070-4. eCollection 2018.
Levodopa-carbidopa intestinal gel (LCIG) is effective for the control of motor fluctuations in Parkinson's disease (PD). The objective of this study is to report the reduction of dyskinesias after transitioning from 16 to 24-h/day LCIG infusion. From a cohort of 74 PD patients treated with LCIG for motor fluctuations, we identified 12 patients that were treated with 24-h per day infusion with the aim to control troublesome daytime dyskinesia. Clinical, demographic, dyskinesia rating scales were evaluated. Daytime dyskinesia was reduced in 75% (9/12) patients following treatment with 24-h therapy, including 7 who were compared with 16-h therapy and 2 that were transitioned from oral dopaminergic therapy to 24-h LCIG. Combining the data from all 12 subjects, troublesome dyskinesias were reduced during 24-h LCIG; UPDRS 4.1 (time spent with dyskinesias) mean change was -1.5 ± 0.75, = 0.010 (Wilcoxon signed-rank test) and UPDRS 4.2 (functional impact of dyskinesias) mean change was -1.7 ± 0.90, = 0.016, without changing their UPDRS part 3 "ON" scores ( = 0.138) or H&Y ( = 0.157). In 5 patients, improvement in dyskinesia occurred despite an overall increase in the total daily levodopa dose. None of the patients had worsening of dyskinesia after a median follow-up of 28 months. 24-h per day infusion of LCIG may be a useful strategy in the management of troublesome dyskinesias in PD patients with disabling dyskinesias resistant to attempts to optimise 16-hours per day therapy. We postulate that this may be due to a pharmacodynamic as opposed to pharmacokinetic mechanism.
左旋多巴-卡比多巴肠凝胶（LCIG）对控制帕金森病（PD）的运动波动有效。本研究的目的是报告从每天16小时LCIG输注过渡到24小时LCIG输注后异动症的减少情况。在一组74例接受LCIG治疗运动波动的PD患者中，我们确定了12例每天接受24小时输注的患者，旨在控制日间烦人的异动症。评估了临床、人口统计学和异动症评分量表。24小时治疗后，75%（9/12）的患者日间异动症减少，其中7例与16小时治疗进行了比较，2例从口服多巴胺能治疗过渡到24小时LCIG治疗。综合所有12名受试者的数据，24小时LCIG治疗期间烦人的异动症减少；统一帕金森病评定量表（UPDRS）4.1（异动症持续时间）平均变化为-1.5±0.75，P = 0.010（Wilcoxon符号秩检验），UPDRS 4.2（异动症的功能影响）平均变化为-1.7±0.90，P = 0.016，而其UPDRS第3部分“开”期评分（P = 0.138）或 Hoehn-Yahr分级（P = 0.157）未改变。在5例患者中，尽管每日左旋多巴总剂量总体增加，但异动症仍有改善。中位随访28个月后，无一例患者异动症恶化。对于每天尝试优化16小时治疗仍有致残性异动症的PD患者，每天24小时输注LCIG可能是管理烦人的异动症的一种有用策略。我们推测这可能是由于药效学而非药代动力学机制。
