1. Duodenal Levodopa Treatment in advanced Parkinson’s Disease
Baciu Diana, MG, VI
Scientific Advisor:
Lecturer: Dr. Szász József-Attila
UMF Târgu Mureș,
Neurology II, Târgu Mureș
Introduction-Pathophysiology-Diagnostic-Treatment-Material and Methods-Results-Conclusion

2. Parkinson’s Syndrome:
Hypo-kinetic hypertonic, extrapyramidal motor syndrome
Progressive, neurodegenerative disease
Heterogenous etiology
Rather affects middle-age people
The onset-age plays an important role in further evolution of the disease
Parkinson’s Syndrome:
Introduction-Pathophysiology-Diagnostic-Treatment-Material and Methods-Results-Conclusion

3. Pathophysiology:
Introduction-Pathophysiology-Diagnostic-Treatment-Material and Methods-Results-Conclusion

4. Pathophysiology: Two major pathological mechanism:
Loss of pigmented dopamine neurons
The presence of Lewy bodies and Lewy neurites
Introduction-Pathophysiology-Diagnostic-Treatment-Material and Methods-Results-Conclusion

5. Clinical Presentation:
Classic Symptoms
Rest Tremor
Bradykinesia/Hypokinesia/Akinesia
Stiff Rigidity
Early Symptoms
Tremor at rest
Muscle rigidity
Stooped posture
Expressionless face
Slow movement
Poor balance and coordination
Advanced Symptoms
Complications of L-Dopa therapy
-Motor fluctuations
-Dyskinesia and Dystonia
Depression
Dementia
Psychosis
Introduction-Pathophysiology-Diagnostic-Treatment-Material and Methods-Results-Conclusion

6. Parkinson’s Disease: Diagnostic
I. Clinical:
Hoehn and Yahr Staging Scale: motor symptoms quantification
Schwab and England activities of daily living (ADL)-scale
Unified Parkinson´s Disease Rating Scale (MDS-UPDRS) :
Therapy monitoring
I: non-motor experiences of daily living II: motor experiences of daily living III: motor examination IV: motor complications
Introduction-Pathophysiology-Diagnostic-Treatment-Material and Methods-Results-Conclusion

7. Parkinson’s Disease: Diagnostic
II. Imaging:
SPECT/PET
CT/MRI
for Diff. Dg.
Transcranial
Doppler-
Sonography
Introduction-Pathophysiology-Diagnostic-Treatment-Material and Methods-Results-Conclusion

8. Motor Fluctuations incidence increase with use of Levodopa
Treatment:
Mild/Youg
PD Patient
Levodopa-Low Dose:
MAOB Inhibitor/Dopamine Agonist
ModeratePD.Pat.
Monotherapy: Higher Doses of L-Dopa
Combination: L-Dopa+ Dopa-Agonists/I-MAOB
Severe/Od
PD Pat.
Duodopa: L-Dopa/Carbidopa intestinal delivery
Deep Brain Stimulation
Monotherapy
>5 years of L-Dopa: 50% P.D.Pat-MF
Motor Fluctuations incidence increase with use of Levodopa
Introduction-Pathophysiology-Diagnostic-Treatment-Material and Methods-Results-Conclusion

9. Complications of treatment with L-DOPA
Chorea, Benign Hereditary; Chorea, Chronic Progressive; Chorea, Rheumatic; Chorea, Senile; Chorea, Sydenham; Dyskinesias, Paroxysmal; Neuroacanthocytosis; Paroxysmal Dyskinesias; Senile Chorea; Sydenham Chorea)
Introduction-Pathophysiology-Diagnostic-Treatment-Material and Methods-Results-Conclusion

10. Motor Fluctuations: Hypokinetic symptoms: “wearing off ”
end of dose akinesia
“sudden off”
“delayed on”
“no on”
“early morning akinesia”
“peak-dose akinesia”
“on-off”
“freezing”
Introduction-Pathophysiology-Diagnostic-Treatment-Material and Methods-Results-Conclusion

11. Aim of the Study Material and Methods
The follow-up of the patients who suffer motor fluctuations , with advanced Parkinson’s disease
Which person requires treatment with intestinal gel
Patients monitoring before and after Duodopa-medication
Comparing performance of motor fluctuations
Material and Methods
The therapeutic method with intestinal gel Levodopa/Carbidopa has been firstly used in the Neurology Clinic II Tg. Mures in June 2011
Until December 2013 , 21 patients with advanced P.D and hypokinetic motor fluctuations were assesed with Duodopa-treatment
Introduction-Pathophysiology-Diagnostic-Treatment-Material and Methods-Results-Conclusion

12. Results I. Distribution according to risc factors
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13. Results I. Distribution according to risc factors
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14. Results II. Distribution on motor fluctuations
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15. Results III. Patient distribution of oral medications
Introduction-Pathophysiology-Diagnostic-Treatment-Material and Methods-Results-Conclusion

16. Treatment with Duodopa: Intestinal Gel
Ideal Patient
Advanced P.D
with max. therapeutic dose
Onset Dose
Good response, without adverse effects: individualized doses
Tester
Test Period: Duodopa-effect was investigated in hospital
Introduction-Pathophysiology-Diagnostic-Treatment-Material and Methods-Results-Conclusion

17. Results: Treatment with Duodopa
Generally, most of the patients presented a decrease in the number of “off-hours”
Introduction-Pathophysiology-Diagnostic-Treatment-Material and Methods-Results-Conclusion

18. Results IV. Clinical Quantification of motor fluctuations
Daily activities of patients and motor symptoms were measured using international scales
Hoehn-Yahr Scale Before and
UPDRS II+III After
Introduction-Pathophysiology-Diagnostic-Treatment-Material and Methods-Results-Conclusion

19. Results: Clinical Quantification of motor fluctuations:
UPDRS II (Daily Activity): The amount of the grade scale for measuring daily activity before treatment was compared with the one after treatment.
Introduction-Pathophysiology-Diagnostic-Treatment-Material and Methods-Results-Conclusion

20. Results: Clinical Quantification of motor fluctuations:
UPDRS III (Motor System):The total amount of the grade scale for measuring motor performance during “ON” before treatment was compared with the one after treatment
Introduction-Pathophysiology-Diagnostic-Treatment-Material and Methods-Results-Conclusion

21. Conclusions: Main causes in the occurrence of M.F are:
Progressive degeneration of dopamine terminals
Short Half-Life of L-Dopa, which produces a discontinous dopamine stimulation
Gastric inactivation of L-Dopa or low absorbtion
Duodopa – Intestinal Gel Administration can solve this issues
- maintaining a constant level of dopamine in the
blood
Objectively, all 21 patients experienced a significant reduction in the fluctuations, while achieving a better gait function
Introduction-Pathophysiology-Diagnostic-Treatment-Material and Methods-Results-Conclusion

22. Thank you for your attention!
Introduction-Pathophysiology-Diagnostic-Treatment-Material and Methods-Results-Conclusion