Galli Silvia, De Carolis Lanfranco, Bianchini Edoardo, Alborghetti Marika, Caliò Bianca, Pacilio Pierre, Fanciulli Alessandra, Pontieri Francesco E, Rinaldi Domiziana
Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), Sapienza University of Rome, Via di Grottarossa, 1035, 00189, Rome, Italy.
Autonomy, Gerontology, E-Health, Imaging & Society (AGEIS), Université Grenoble Alpes, 38000, Grenoble, France.
Clin Auton Res. 2025 Apr;35(2):159-182. doi: 10.1007/s10286-024-01090-9. Epub 2024 Dec 4.
Autonomic failure has a major impact on the quality of life of individuals with Parkinson's disease (PD), especially in advanced stages of the disease. Levodopa/carbidopa intestinal gel (LCIG) infusion is a well-established treatment for advanced PD with severe motor fluctuations and provides substantial benefit in managing some non-motor symptoms (NMS), such as sleep, fatigue, and neuropsychiatric issues. The effect of LCIG on autonomic symptoms is by contrast not well known. Here we performed a systematic review on the influence of LCIG therapy on autonomic dysfunction in PD individuals.
Following the PRISMA guidelines, we systematically searched for studies that included autonomic outcome measures in LCIG-treated PD individuals, limiting the search to articles written in English and published between January 2005 and June 2023. We evaluated improvement, stability, or worsening of gastrointestinal, urinary, and cardiovascular symptoms at six different timepoints according to clinimetric scale changes compared to baseline. Data on autonomic adverse events (AEs) possibly related to LCIG treatment were also collected.
Of the 1476 studies identified in the initial search, 16 ultimately met the inclusion criteria and underwent quality assessment and data extraction, with data from 1361 PD patients (18.3 months mean follow-up). Thirteen studies reported improvement or stability of gastrointestinal, urinary, and cardiovascular symptoms over the interventional period. One study found a worsening of cardiovascular symptoms and two of urological symptoms. Regarding safety, seven studies reported gastrointestinal (8.4%), urinary (0.5%), and cardiovascular (1.1%) autonomic LCIG-related AEs.
LCIG infusion may help to reduce the burden of autonomic symptoms in advanced PD. Prospective studies specifically addressing the effect of LCIG on autonomic function in advanced PD are warranted.
自主神经功能衰竭对帕金森病（PD）患者的生活质量有重大影响，尤其是在疾病晚期。左旋多巴/卡比多巴肠凝胶（LCIG）输注是治疗晚期PD伴严重运动波动的一种成熟疗法，在管理一些非运动症状（NMS）方面，如睡眠、疲劳和神经精神问题，具有显著益处。相比之下，LCIG对自主神经症状的影响尚不明确。在此，我们对LCIG治疗对PD患者自主神经功能障碍的影响进行了系统评价。
按照PRISMA指南，我们系统检索了包含LCIG治疗的PD患者自主神经结局指标的研究，检索范围限于2005年1月至2023年6月发表的英文文章。根据与基线相比的临床量表变化，我们在六个不同时间点评估了胃肠道、泌尿系统和心血管系统症状的改善、稳定或恶化情况。还收集了可能与LCIG治疗相关的自主神经不良事件（AE）的数据。
在初步检索中确定的1476项研究中，16项最终符合纳入标准，并进行了质量评估和数据提取，数据来自1361例PD患者（平均随访18.3个月）。13项研究报告了干预期间胃肠道、泌尿系统和心血管系统症状的改善或稳定情况。一项研究发现心血管系统症状恶化，两项研究发现泌尿系统症状恶化。关于安全性，7项研究报告了与LCIG相关的胃肠道（8.4%）、泌尿系统（0.5%）和心血管系统（1.1%）自主神经AE。
LCIG输注可能有助于减轻晚期PD患者的自主神经症状负担。有必要开展前瞻性研究，专门探讨LCIG对晚期PD患者自主神经功能的影响。
