Intrajejunal Levodopa Infusion for Parkinson's Disease over 11 years: A Canadian Experience
Chetan Vekhande1, Moath Hamed4, Genise Tremain5, Jennifer Mah5, Aakash Shetty1, Adriana Lazarescu2, Oksana Suchowersky3
1Medicine (Neurology), 2Department of Medicine, Division of Gastroenterology, 3Medicine (Neurology), Pediatrics and Medical Genetics, University of Alberta, 4Neurology, Weill Cornell Medicine, 5Movement Disorders Program, Kaye Edmonton Clinic, Alberta Health services
Objective:
To analyze long-term experience in the clinical management of Parkinson's disease (PD) patients with intrajejunal levodopa infusion (ILI) therapy over 11 years.
Background:
ILI therapy is a safe and effective drug delivery method for advanced Parkinson’s disease with proven short-term efficacy and safety profile. Limited data is available regarding long-term benefits and complications. ILI is done at the University of Alberta Hospital in a multidisciplinary clinic including neurology, gastroenterology, psychiatry, PT, OT, and specialized nursing.
Design/Methods:
Retrospective chart review was done for patients with PD who underwent ILI from 2011 to 2022. Data collected included dosing, UPDRS-III motor scores, OFF times, hours with dyskinesias, MoCA scores, complications, discontinuation reasons, and nursing time requirements.
Results:
Thirty-three patients received ILI therapy with a mean follow up of 3.25 + 2.09 years. Over 11 years, 6 (18.1%) patients discontinued treatment due to side effects or lack of efficacy, 2 (6.06%) transitioned to DBS therapy, and 11 (33.3%) died of causes unrelated to ILI infusion. One patient died from haematemesis related to a coiled PEG-J tube. UPDRS-III score showed relative reduction by 16.3% from baseline (mean 33) maintained for 4 years (mean 28). Mean daily OFF time improved from baseline (mean 7.1+3.13 hours) up to 5 years (mean 3.3+2.31 hours; -73.07%; p - 0.048). Dyskinesias remained stable. Nursing time averaged 22 hours per patient per year after PEG-J insertion and titration. Most common complications were PEG-J tube dislodgement and pump malfunction in 18 (54.5%) patients over the study period.
Conclusions:
Patients on ILI had improved motor scores, reduced OFF-times, and stable dyskinesias over 5-year follow-up. Most common complication was PEG-J dislodgement; serious complications were uncommon. Nursing time requirements necessitate ILI trained nurses.