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Levodopa infusion improves impulsivity and dopamine dysregulation syndrome in Parkinson's disease

Authors

  • María José Catalán MD, PhD,

    Corresponding author
    1. Movement Disorders Unit, Department of Neurology, Hospital Clínico San Carlos, Universidad Complutense, Madrid, Spain
    • Correspondence to: Dr. María José Catalán, Movement Disorders Unit, Department of Neurology, Hospital Clínico San Carlos, C/ Profesor Martín Lagos s/n, E-28040 Madrid, Spain; mariajose.catalan@salud.madrid.org

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  • Eduardo de Pablo-Fernández MD,

    1. Movement Disorders Unit, Department of Neurology, Hospital Clínico San Carlos, Universidad Complutense, Madrid, Spain
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  • Clara Villanueva MD,

    1. Movement Disorders Unit, Department of Neurology, Hospital Clínico San Carlos, Universidad Complutense, Madrid, Spain
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  • Servando Fernández-Diez MD,

    1. Department of Gastroenterology, Hospital Clínico San Carlos, Universidad Complutense, Madrid, Spain
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  • Teresa Lapeña-Montero MD,

    1. Movement Disorders Unit, Department of Neurology, Hospital Clínico San Carlos, Universidad Complutense, Madrid, Spain
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  • Rocío García-Ramos MD, PhD,

    1. Movement Disorders Unit, Department of Neurology, Hospital Clínico San Carlos, Universidad Complutense, Madrid, Spain
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  • Eva López-Valdés MD, PhD

    1. Movement Disorders Unit, Department of Neurology, Hospital Clínico San Carlos, Universidad Complutense, Madrid, Spain
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  • Funding agencies: This study was partially supported by a grant from Ministerio de Ciencia e Innovación, Instituto Carlos III, Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED INTCBN 09/203), Madrid, Spain.

  • Relevant conflicts of interest/financial disclosures: Nothing to report.

  • Full financial disclosures and author roles may be found in the online version of this article.

ABSTRACT

Background

Impulsivity and dopamine dysregulation syndrome are frequent complications of treatment in Parkinson's disease (PD).

Methods

We assessed the effect of jejunal levodopa infusion (JLI) on behavioral symptoms in 8 PD patients with motor complications and severe impulsivity and dopamine dysregulation syndrome (DDS), which had not be controlled before by adjusting oral medications. The infusion was delivered during 15 hours (daily dose 1007.2 ± 302.5 mg) and stopped at night time. Patients were reassessed after 25 ± 9 weeks of treatment with a stable dose of jejunal l-dopa.

Results

Off periods and dyskinesias decreased by 27% and 20,7% respectively, compared to baseline. DDS and all types of impulse control disorders (ICDs) improved in all patients, with nearly complete symptom resolution. Punding improved in all 5 patients but disappeared completely in only 1.

Conclusions

Our experience suggests that l-dopa infusion has a positive effect on both motor complications and behavioral disorders. This treatment approach deserves further controlled studies. © 2013 International Parkinson and Movement Disorder Society

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