Highlights
- •Roughly 14% patients on LCIG manifests complex dyskinesias.
- •Complex dyskinesias are commonly biphasic-like.
- •A subgroup with superimposed peak dyskinesias more frequently discontinue LCIG.
- •Pre-existent biphasic dyskinesias might promote complex dyskinesias after LCIG.
- •LCIG should be carefully adopted in patients with troublesome dyskinesias.
Abstract
Background
Levodopa-carbidopa intestinal infusion is an effective treatment for motor fluctuations
in Parkinson's disease. However, it has been recently associated with emergent complex/atypical
dyskinesias. We sought to characterize patients who developed these dyskinesias after
levodopa infusion initiation, and to compare these patients to a control population
with conventional motor fluctuations.
Methods
208 Parkinson's disease patients, treated with levodopa intestinal infusion due to
motor fluctuations, were screened for onset and/or worsening of dyskinesias after
initiation of levodopa infusion, resistant to the routine titration, and presenting
with atypical or unexpected patterns. Patients with extensive follow-up data were
enrolled for a longitudinal analysis. Cases were compared to a control sample with
conventional motor fluctuations in order to investigate predisposing factors, difference
in dyskinesia phenotype, management strategies and dropouts.
Results
Thirty patients out of 208 (14.4%) reported atypical (i.e. long-lasting) biphasic,
biphasic-like (i.e. continuous) or mixed (peak-dose and continuous biphasic) dyskinesias
after levodopa infusion. They were compared at baseline and follow-up to a sample
of 49 patients with conventional motor fluctuations on levodopa infusion. Both groups
had similar demographic and clinical features, except the former having higher prevalence
of biphasic dyskinesias while on oral therapy. Biphasic-like dyskinesias in nearly
half the number of cases improved with increasing the dopaminergic load, while mixed
dyskinesias had the worst outcome and highest dropout rate (58%).
Conclusions
Atypical biphasic, biphasic-like and complex dyskinesias could hinder the course of
patients treated with levodopa infusion. This study further informs the selection
process of advanced therapies, particularly in dyskinetic patients.
Keywords
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Article info
Publication history
Published online: November 14, 2019
Accepted:
November 9,
2019
Received:
July 26,
2019
Identification
Copyright
© 2019 Elsevier Ltd. All rights reserved.
