Duodopa pump treatment in patients with advanced Parkinson's disease

Patients with advanced Parkinson's disease (PD) often develop motor complications including fluctuations and involuntary movements (dyskinesias). In Denmark, treatment has comprised Deep Brain Stimulation (DBS) since the late 1990s, and as from 2002 use of a subcutaneous apomorphine pump. Monotherapy with continuous intestinal levodopa infusion to the duodenum (Duodopa) was introduced in 2004.

A total of 14 PD patients were assessed for Duodopa pump therapy in the 2004-2008 period. After an initial test week, 12 of the patients had a permanent percutaneous endoscopic gastrostomy (PEG) tube inserted containing a smaller intestinal tube terminating in the duodenum. Before and after treatment initiation, we evaluated the patients using clinical rating scales and video recordings.

Objectively, all 12 patients experienced a significant reduction in fluctuations and dyskinesias while achieving a better gait function. Three patients received Duodopa as 24-hour treatment with good effect on severe nocturnal dystonic pain. One patient suffered a severe complication (peritonitis).

Duodopa has a symptom-relieving and stabilizing effect without side effects, but entails a risk of surgical complications (peritonitis).