%0 Journal Article
%T Impact of Duodopa on Quality of Life in Advanced Parkinson's Disease: A UK Case Series
%A T. Foltynie
%A C. Magee
%A C. James
%A G. J. M. Webster
%A A. J. Lees
%A P. Limousin
%J Parkinson's Disease
%D 2013
%I Hindawi Publishing Corporation
%R 10.1155/2013/362908
%X Treatment options in advanced Parkinson¡¯s disease (PD) include subcutaneous apomorphine, pallidal or subthalamic nucleus Deep Brain Stimulation (DBS), or levodopa/carbidopa intestinal gel (LCIG/Duodopa). In this study, we describe the outcome of 12 PD patients with PD related complications started on LCIG, with respect to their quality of life measured by a disease specific validated scale¡ªthe PDQ39, together with diaries recording time spent ¡°On,¡± ¡°Off,¡± ¡°Dyskinetic,¡± or ¡°Asleep.¡± At the time of latest follow up, improvements were observed in both the PDQ39 Summary index as well as diary reports of PD symptom control following introduction of LCIG, supporting its use in well selected patients. The use of a trial period of LCIG via naso-jejunal administration allows objective evaluation of improvement in PD symptom control in advance of the placement of the more invasive percutaneous jejunostomy procedure. The decision to embark on LCIG, apomorphine or DBS should be supported by input from centres with experience of all 3 approaches. Since LCIG is an expensive option, development of the most appropriate future commissioning of this therapy in the absence of Class 1 evidence requires careful scrutiny of the outcomes of its use in a broad range of published series. 1. Introduction One of the key outcomes for the UK National Health Service Outcomes Framework 2012/2013 is ¡°Enhancing the quality of life for people with long term conditions.¡± Neurodegenerative diseases including Parkinson¡¯s disease (PD) represent a major target area for outcome improvement. While the majority of patients with Parkinson¡¯s disease respond well to conventional oral medication, some patients (particularly those with young onset PD) survive for many decades with the illness and, in the later or ¡°advanced¡± stages, experience severe disabling complications emerging from the combination of advancing degeneration and chronic medication use. These complications consist of severe adventitious involuntary movements often referred to as L-dopa-induced dyskinesias, and unpredictable ¡°On/Off¡± fluctuations, necessitating the use of other strategies to maintain acceptable quality of life. Oral and transdermal anti-Parkinsonian therapy fails to provide sufficient relief from the symptoms of advanced PD in a significant proportion of patients, in whom consideration should be given regarding the use of subcutaneous apomorphine, subthalamic or pallidal Deep Brain stimulation (DBS), or levodopa/carbidopa intestinal gel (LCIG/Duodopa). Patients reaching the advanced stages of PD while still
%U http://www.hindawi.com/journals/pd/2013/362908/