Diphasic dyskinesias during levodopa-carbidopa intestinal gel (LCIG) infusion in Parkinson's disease |
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| Affiliation: | 1. Service de neurologie et pathologie du mouvement, hôpital Roger-Salengro, CHRU de Lille, rue Émile-Laine, 59037 Lille cedex, France;2. EA 4559, université Lille Nord de France, hôpital Roger-Salangro, rue Émile-Laine, 59037 Lille cedex, France;3. EA 2694, service de biostatistiques, université Lille Nord de France, CHRU de Lille, rue Émile-Laine, 59037 Lille, France;4. Inserm, UMR 837, Team 6, JPArc, IRCL, 2, avenue Oscar-Lambret, 59037 Lille cedex, France;1. Department of Psychology, University of Florida, Gainesville, FL, 32611, USA;2. Brain Rehabilitation Research Center, Malcom Randall VA Medical Center, Gainesville, FL, 32608, USA;3. Department of Neurology, University of Florida, College of Medicine, Gainesville, FL 32610, USA;4. Geriatric Research Education and Clinical Center Malcom Randall VA Medical Center, Gainesville, FL, 32608, USA;5. Center for Neuropsychological Studies, University of Florida, Gainesville, FL 32611, USA;1. Chulalongkorn Centre of Excellence for Parkinson''s Disease and Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand;2. Parkinson Foundation International Centre of Excellence, Kings College Hospital and Kings College, Denmark Hill Campus, London, United Kingdom;3. Department of Neurology, University Medical Centre, Groningen, Netherlands;4. The Academy of Science, The Royal Society of Thailand, Bangkok, Thailand |
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| Abstract: | ObjectivesLevodopa-carbidopa intestinal gel infusion (LCIG) is indicated in patients with advanced levodopa-responsive Parkinson's disease (PD) for the treatment of motor fluctuations and dyskinesias. Here we describe 4 PD patients who developed disabling diphasic dyskinesias after LCIG initiation.MethodsThe clinical data of 33 PD patients consecutively treated with LCIG therapy were obtained through direct clinical observation and detailed review of medical records.ResultsWithin 10 days, after LCIG introduction, we identified 4 subjects (12.1%) with persistent and disabling diphasic dyskinesia (DD). We tried to manage these symptoms by increasing morning LCIG flow and adding “extended-release” formulations of dopamine-agonists and levodopa/carbidopa during bedtime. Within 1 month, all patients presented a gradual reduction in the duration and severity of DD.ConclusionsTo our knowledge, this is the first report describing the occurrence of DD in a small cohort of advanced PD patients after LCIG initiation. We wish to draw the attention of clinicians to the risk of developing disabling DD in PD patients switched to the LCIG monotherapy. |
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| Keywords: | Parkinson's disease Diphasic dyskinesias Levodopa-carbidopa intestinal gel (LCIG) |
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