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Levodopa-Induced Neuropathy: A Systematic Review.

Alberto Romagnolo1, Aristide Merola2, Carlo Alberto Artusi1

  • 1Department of Neuroscience "Rita Levi Montalcini" University of Turin Torino Italy.

Movement Disorders Clinical Practice
|March 7, 2019
PubMed
Summary

Parkinson's disease patients on levodopa may develop peripheral neuropathy, especially with intestinal gel infusion. Vitamin B supplementation shows preliminary promise in managing this condition.

Keywords:
LCIGParkinson's diseaselevodopaneuropathysmall fibers

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Area of Science:

  • Neurology
  • Pharmacology

Background:

  • Evidence suggests a link between Parkinson's disease (PD) and peripheral neuropathy (PNP).
  • Levodopa metabolic products like homocysteine may play a causative role in PD-associated PNP.

Purpose of the Study:

  • To systematically review cases of PNP in levodopa-treated PD patients.
  • To analyze the prevalence and characteristics of PNP in different levodopa treatment forms.

Main Methods:

  • Systematic review of studies published between January 1990 and March 2018.
  • Analysis of cases of PNP in Parkinson's disease patients treated with oral levodopa or levodopa/carbidopa intestinal gel infusion (LCIG).

Main Results:

  • PNP prevalence was 30.2% with oral levodopa and 42.1% with LCIG.
  • LCIG was associated with a higher incidence of acute/subacute PNP (35.7%).
  • PNP correlated with higher levodopa doses, elevated homocysteine, reduced vitamin B12, elevated methylmalonic acid, and reduced vitamin B6; small fiber neuropathy was common (93.4%).

Conclusions:

  • Over one-third of levodopa-treated PD patients may develop PNP, with LCIG showing higher acute/subacute forms.
  • Pathogenic mechanisms likely involve neurodegeneration and levodopa neurotoxic metabolites.
  • Further randomized trials are needed to confirm factors influencing PD-associated PNP and the role of vitamin B supplementation.