González-Herrero Belén, Jauma-Classen Serge, Gómez-Llopico Roser, Plans Gerard, Calopa Matilde
Bellvitge University Hospital-Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain.
Parkinsons Dis. 2020 May 14;2020:1627264. doi: 10.1155/2020/1627264. eCollection 2020.
Treatment of freezing of gait (FOG) is always challenging because of its unpredictable nature and multifactorial physiopathology. Intestinal levodopa infusion has been proposed in recent years as a valuable option for its improvement. FOG in Parkinson's disease (PD) can appear after deep brain stimulation in patients who never had gait symptoms.
To study the effects of intestinal levodopa/carbidopa infusion in unresponsive-FOG that appears in PD patients treated with subthalamic nucleus deep brain stimulation.
We retrospectively collected and analyzed demographic, clinical, and therapeutic data from five PD patients treated with subthalamic nucleus stimulation who developed unresponsive-FOG and received intestinal levodopa/carbidopa infusion as an alternative therapy. FOG was measured based on scores in item 14 of the Unified Parkinson's Disease Rating Scale before and after intestinal levodopa infusion.
Administration of intestinal levodopa caused improvement of FOG in the "ON" state in four patients (80%) by 2 or more points in item 14 of the Unified Parkinson's Disease Rating Scale. The improvement was maintained for at least 12 months.
Intestinal levodopa infusion may be a valuable therapeutic option for unresponsive-FOG developed after subthalamic nucleus deep brain stimulation.
冻结步态（FOG）的治疗一直具有挑战性，因为其性质不可预测且生理病理机制具有多因素性。近年来，肠道左旋多巴输注已被提议作为改善FOG的一种有价值的选择。帕金森病（PD）患者在接受丘脑底核深部脑刺激后，可能会出现此前从未有过的步态症状，进而引发冻结步态。
研究肠道左旋多巴/卡比多巴输注对接受丘脑底核深部脑刺激治疗的PD患者出现的难治性冻结步态的影响。
我们回顾性收集并分析了5例接受丘脑底核刺激治疗且出现难治性冻结步态并接受肠道左旋多巴/卡比多巴输注作为替代治疗的PD患者的人口统计学、临床和治疗数据。在肠道左旋多巴输注前后，根据统一帕金森病评定量表第14项的评分来测量冻结步态。
4例患者（80%）在肠道左旋多巴输注后，统一帕金森病评定量表第14项在“开”状态下的冻结步态改善了2分或更多。这种改善持续了至少12个月。
肠道左旋多巴输注可能是丘脑底核深部脑刺激后出现的难治性冻结步态的一种有价值的治疗选择。
