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Non-motor symptoms may improve after treatment with Levodopa–Carbidopa intestinal gel in patients with advanced Parkinson's disease


Researchers have analyzed the evolution of non-motor symptoms and patients’ and neurologists’ clinical global impression ( CGI ) in advanced Parkinson's disease patients treated with Levodopa–Carbidopa intestinal gel ( LCIG; Duodopa; Duopa ).

Patients with advanced Parkinson's disease from 18 Spanish sites treated with Levodopa–Carbidopa intestinal gel between January 2006 and December 2011 were included in this observational, retrospective study.
Impression of change in 31 non-motor symptoms ( rated on a seven-point Likert scale from strong worsening to great improvement ) and patients’ ( P-GIC ) and neurologists’ ( C-GIC ) global impression of change scores were collected from a single evaluation at enrollment.

52.0% of the patients were male and mean age was 70.1 ± 8.0 years ( n=123 ). Mean number of non-motor symptoms per patient was 22.3 ± 5.5 and 64.5% of the patients presented more than 20 non-motor symptoms.

After treatment with Levodopa–Carbidopa intestinal gel, 121 patients reported a total number of 2702 non-motor symptoms, of which 35.3% improved, 38.9% remained equal and 25.8% worsen.
Non-motor symptoms with greatest improvements were dizziness ( 59.7% ), fatigue ( 57.6% ) and flat mood ( 56.0% ).

Global improvement was reported by 86.8% ( 45.5% great improvement ) of patients and 88.6% ( 50.4% great improvement ) of physicians according to P-GIC and C-GIC scores, respectively.
In the efficacy index ( CGI-E ) a 77.7% of the patients had a marked or moderate therapeutic effect without adverse events or with adverse events that did not significantly interfere with patients’ functioning.

In conclusion, non-motor symptoms are prevalent in advanced Parkinson’s disease and may improve after treatment with Levodopa–Carbidopa intestinal gel, as e.g. dizziness, fatigue and flat mood.
Additional studies are required to confirm these results.
Levodopa–Carbidopa intestinal gel seems to have a beneficial effect according to CGI of patients and neurologists. ( Xagena )

Parra JC et al, Movement Disorders 2015;30 Suppl 1 :447

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