Direct Initiation of Levodopa–Carbidopa Intestinal Gel Infusion After a Positive Levodopa Challenge Test in Advanced Parkinson's Disease
ABSTRACT Introduction Levodopa–carbidopa intestinal gel (LCIG) is an established treatment option in advanced Parkinson's disease (PD). LCIG treatment is usually initiated with a nasojejunal tube (NJT) test phase before percutaneous endoscopic transgastric jejunostomy (PEG‐J) tube installation....
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| Format: | Article |
| Language: | English |
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Wiley
2024-12-01
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| Series: | Brain and Behavior |
| Online Access: | https://doi.org/10.1002/brb3.70193 |
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| author | Vili Viljaharju Tuomas Mertsalmi K. Amande M. Pauls Maija Koivu Johanna Eerola‐Rautio Marianne Udd Eero Pekkonen |
| author_facet | Vili Viljaharju Tuomas Mertsalmi K. Amande M. Pauls Maija Koivu Johanna Eerola‐Rautio Marianne Udd Eero Pekkonen |
| author_sort | Vili Viljaharju |
| collection | DOAJ |
| description | ABSTRACT Introduction Levodopa–carbidopa intestinal gel (LCIG) is an established treatment option in advanced Parkinson's disease (PD). LCIG treatment is usually initiated with a nasojejunal tube (NJT) test phase before percutaneous endoscopic transgastric jejunostomy (PEG‐J) tube installation. However, some centers have used direct initiation with PEG‐J. Data comparing these approaches are scarce. The objective of this study was to analyze the risks and benefits of direct PEG‐J initiation after a positive levodopa challenge test (LCT) for selected patients compared to initiation with a temporary NJT test phase. Methods Thirty‐three consecutive advanced PD patients commenced LCIG‐treatment between February 2016 and December 2019 at Helsinki University Hospital. Of them, 11 (33%) selected patients had direct initiation without an NJT test phase. Treatment discontinuations and adverse events during the first 6 months of treatment were evaluated retrospectively. The duration of hospital stay related to the initiation of the treatment was compared between the groups. Results Between the direct initiation and NJT test phase groups, there were no significant differences in treatment discontinuations (0 vs. 1, respectively); the number of inner tube or PEG‐J tube replacements (1 vs. 3); or infection complications (1 vs. 3) during the first 6 months of treatment. Direct initiation significantly reduced the hospital stay related to treatment initiation (mean 7 vs. 9 days, p = 0.001). Conclusion For selected patients, the direct initiation of LCIG after a positive LCT, without a temporary NJT test phase, appears safe and does not lead to additional treatment discontinuations or complications. |
| format | Article |
| id | doaj-art-35f93951bff94cefb094bd40f12e2f5a |
| institution | OA Journals |
| issn | 2162-3279 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | Wiley |
| record_format | Article |
| series | Brain and Behavior |
| spelling | doaj-art-35f93951bff94cefb094bd40f12e2f5a2025-08-20T01:57:48ZengWileyBrain and Behavior2162-32792024-12-011412n/an/a10.1002/brb3.70193Direct Initiation of Levodopa–Carbidopa Intestinal Gel Infusion After a Positive Levodopa Challenge Test in Advanced Parkinson's DiseaseVili Viljaharju0Tuomas Mertsalmi1K. Amande M. Pauls2Maija Koivu3Johanna Eerola‐Rautio4Marianne Udd5Eero Pekkonen6Department of Neurology Helsinki University Hospital Helsinki FinlandDepartment of Neurology Helsinki University Hospital Helsinki FinlandDepartment of Neurology Helsinki University Hospital Helsinki FinlandDepartment of Neurology Helsinki University Hospital Helsinki FinlandDepartment of Neurology Helsinki University Hospital Helsinki FinlandDepartment of Gastroenterological Surgery Helsinki University Hospital Helsinki FinlandDepartment of Neurology Helsinki University Hospital Helsinki FinlandABSTRACT Introduction Levodopa–carbidopa intestinal gel (LCIG) is an established treatment option in advanced Parkinson's disease (PD). LCIG treatment is usually initiated with a nasojejunal tube (NJT) test phase before percutaneous endoscopic transgastric jejunostomy (PEG‐J) tube installation. However, some centers have used direct initiation with PEG‐J. Data comparing these approaches are scarce. The objective of this study was to analyze the risks and benefits of direct PEG‐J initiation after a positive levodopa challenge test (LCT) for selected patients compared to initiation with a temporary NJT test phase. Methods Thirty‐three consecutive advanced PD patients commenced LCIG‐treatment between February 2016 and December 2019 at Helsinki University Hospital. Of them, 11 (33%) selected patients had direct initiation without an NJT test phase. Treatment discontinuations and adverse events during the first 6 months of treatment were evaluated retrospectively. The duration of hospital stay related to the initiation of the treatment was compared between the groups. Results Between the direct initiation and NJT test phase groups, there were no significant differences in treatment discontinuations (0 vs. 1, respectively); the number of inner tube or PEG‐J tube replacements (1 vs. 3); or infection complications (1 vs. 3) during the first 6 months of treatment. Direct initiation significantly reduced the hospital stay related to treatment initiation (mean 7 vs. 9 days, p = 0.001). Conclusion For selected patients, the direct initiation of LCIG after a positive LCT, without a temporary NJT test phase, appears safe and does not lead to additional treatment discontinuations or complications.https://doi.org/10.1002/brb3.70193 |
| spellingShingle | Vili Viljaharju Tuomas Mertsalmi K. Amande M. Pauls Maija Koivu Johanna Eerola‐Rautio Marianne Udd Eero Pekkonen Direct Initiation of Levodopa–Carbidopa Intestinal Gel Infusion After a Positive Levodopa Challenge Test in Advanced Parkinson's Disease Brain and Behavior |
| title | Direct Initiation of Levodopa–Carbidopa Intestinal Gel Infusion After a Positive Levodopa Challenge Test in Advanced Parkinson's Disease |
| title_full | Direct Initiation of Levodopa–Carbidopa Intestinal Gel Infusion After a Positive Levodopa Challenge Test in Advanced Parkinson's Disease |
| title_fullStr | Direct Initiation of Levodopa–Carbidopa Intestinal Gel Infusion After a Positive Levodopa Challenge Test in Advanced Parkinson's Disease |
| title_full_unstemmed | Direct Initiation of Levodopa–Carbidopa Intestinal Gel Infusion After a Positive Levodopa Challenge Test in Advanced Parkinson's Disease |
| title_short | Direct Initiation of Levodopa–Carbidopa Intestinal Gel Infusion After a Positive Levodopa Challenge Test in Advanced Parkinson's Disease |
| title_sort | direct initiation of levodopa carbidopa intestinal gel infusion after a positive levodopa challenge test in advanced parkinson s disease |
| url | https://doi.org/10.1002/brb3.70193 |
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