1. The evolution of non-motor symptoms in patients with Parkinson’s disease treated with Duodopa intestinal gel Natalia Pritcan Doctor Jozsef Attila Szasz Faculty of Medicine, UMPh Targu Mureş Department of Neurology II, Faculty of Medicine, UMPh Targu Mureş

2. Introduction Parkinson's disease most often develops after age 50. It is one of the most common nervous system disorders of the elderly. Early in the course of the disease, the most obvious symptoms are movement-related; these include shaking, rigidity, slowness of movement and difficulty with walking and gait. Later, thinking and behavioral problems may arise, with dementia commonly occurring in the advanced stages of the disease, where depression is the most common psychiatric symptom. Other symptoms include sensory, sleep and emotional problems.

3. Neurodegenerative diseases including Parkinson’s disease represent a major target area for outcome improvement.

4. There is no cure for Parkinson's disease, but it can be managed and the symptoms of the disease can be relieved or reduced. Levodopa/Carbidopa intestinal gel (Duodopa) is used to treat advanced Parkinson’s disease.

5. Aim The purpose of our study is to observe the benefits of the use of enteral L-dopa infusion on non-motor symptoms for a period of six months at patients with advanced Parkinson’s disease.

6. Material and method We performed a retrospective study of 18 patients with advanced Parkinson’s disease, hospitalized in Neurology Clinic of Targu Mures County Clinical Emergency Hospital which were selected for treatment with Duodopa. Each patient was questioned according to the “Non- Motor Symptom Assessment Scale for Parkinson’s Disease” during an interview at the beginning of treatment and after six months of treatement with Duodopa.

7.  The used scale comprises 9 domains: Cardiovascular Sleep Mood Perceptual problems Attention/Memory Gastrointestinal tract Urinary Sexual function Miscellaneous  Each symptom included in this scale was scored respecting the severity and the frequency.

9. Scores obtained at the beginning of treatment:

10. Scores obtained after six months of treatement with Duodopa:

11. Interpretation: Cardiovascular domain is the only with an unfavorable progres: 16–>26 Sleep\fatigue: 262 –>212 Mood\cognition: 169 –>140 Perceptual problems\ hallucinations: 25 –>19 Attention/Memory: 77 –>71 Gastrointestinal tract: 160 –>130 Urinary: 192 –>134 Sexual function: 181 –>121 the most significant improvement Miscellaneous: 151 –>142

12. Conclusions: The use of enteral L-dopa infusion in the treatment of advanced Parkinson’s desease has developed over the last 20 years. By providing a continuous flow of medication directly to the intestines, where it is absorbed, Duodopa can help maintain a constant level of levodopa in the blood and by that it decreases the number of times a patient alternates between stiffness and uncontrolled movements (on/off). After six months of treatement with Duodopa intestinal gel we noticed a significant improvement of non motor symptoms in patients with advanced Parkinson's disease

13. Thank you!