József Attila Szász1,2, Szabolcs Szatmári1,2, Viorelia Constantin2, István Mihály1,2, Attila Rácz3, Lajos Csaba Domokos4, Tamás Vajda5, Károly Orbán-Kis1,2. 1. Marosvásárhelyi Orvosi és Gyógyszerészeti Egyetem Strada Gheorghe Marinescu 38, Târgu Mureș 540139, Románia. 2. 2. Sz. Ideggyógyászati Klinika, Maros Megyei Sürgősségi Kórház Marosvásárhely, Románia. 3. 2. Sz. Elmegyógyászati Klinika, Maros Megyei Sürgősségi Kórház Marosvásárhely, Románia. 4. Pszichiátria Osztály, Csíkszeredai Megyei Sürgősségi Kórház Csíkszereda, Románia. 5. Marosvásárhelyi Kar, Sapientia Erdélyi Magyar Tudományegyetem Marosvásárhely, Románia.
Abstract
Introduction: The motor and non-motor complications of Parkinson's disease impair the patients' quality of life and limit therapeutical options. There are no clear criteria for 'advanced' Parkinson's disease or for the optimal moment for invasive therapies. There is little evidence regarding the upper limits of levodopa doses, and how these may be influenced by the availability of device-aided therapies. Aim: To analyze substitution therapy in patients with advanced Parkinson's disease. Method: In our retrospective study, we analyzed the data from all patients with advanced Parkinson's disease hospitalized between 1st June 2011 and 31st May 2017, receiving combined levodopa treatment at least 4×/day, reporting a minimum of 2 hours off periods, with or without dyskinesia. We analyzed levodopa therapy for patients who were recommended either device-aided or conservative therapy. Results: Out of 311 patients with advanced Parkinson's disease, for 125 we proposed device-aided therapies whereas in 42 patients we increased the levodopa dose. The average levodopa doses and the administration rate were higher for the 107 patients tested for levodopa-carbidopa intestinal gel. Disease duration, mean levodopa doses and frequency of dosing were all higher in patients proposed for device-aided therapies versus patients with continued conservative treatment. Conclusion: Our patients were on lower levodopa doses (compared to literature), but the combinations were used more often. Device-aided therapies should be considered in patients with severe motor complications who receive at least 750-1000 mg levodopa daily, divided minimum 5×/day. These patients need to be tested in specialized centers by multidisciplinary teams in order to make the best decision for further action. Orv Hetil. 2019; 160(17): 662-669.
Introduction: The motor and non-motor complications of Parkinson's disease impair the patients' quality of life and limit therapeutical options. There are no clear criteria for 'advanced' Parkinson's disease or for the optimal moment for invasive therapies. There is little evidence regarding the upper limits of levodopa doses, and how these may be influenced by the availability of device-aided therapies. Aim: To analyze substitution therapy in patients with advanced Parkinson's disease. Method: In our retrospective study, we analyzed the data from all patients with advanced Parkinson's disease hospitalized between 1st June 2011 and 31st May 2017, receiving combined levodopa treatment at least 4×/day, reporting a minimum of 2 hours off periods, with or without dyskinesia. We analyzed levodopa therapy for patients who were recommended either device-aided or conservative therapy. Results: Out of 311 patients with advanced Parkinson's disease, for 125 we proposed device-aided therapies whereas in 42 patients we increased the levodopa dose. The average levodopa doses and the administration rate were higher for the 107 patients tested for levodopa-carbidopa intestinal gel. Disease duration, mean levodopa doses and frequency of dosing were all higher in patients proposed for device-aided therapies versus patients with continued conservative treatment. Conclusion: Our patients were on lower levodopa doses (compared to literature), but the combinations were used more often. Device-aided therapies should be considered in patients with severe motor complications who receive at least 750-1000 mg levodopa daily, divided minimum 5×/day. These patients need to be tested in specialized centers by multidisciplinary teams in order to make the best decision for further action. Orv Hetil. 2019; 160(17): 662-669.
Authors: József Attila Szász; Viorelia Adelina Constantin; Károly Orbán-Kis; Ligia Ariana Bancu; Simona Maria Bataga; Marius Ciorba; Előd Nagy; Mircea Radu Neagoe; István Mihály; Róbert Máté Szász; Krisztina Kelemen; Mihaela Simu; Szabolcs Szatmári Journal: Pharmaceutics Date: 2022-05-24 Impact factor: 6.525
Authors: József Attila Szász; Viorelia Adelina Constantin; Károly Orbán-Kis; Attila Rácz; Ligia Ariana Bancu; Dan Georgescu; János Szederjesi; István Mihály; Ana-Mária Fárr; Krisztina Kelemen; Tamás Vajda; Szabolcs Szatmári Journal: Neuropsychiatr Dis Treat Date: 2019-11-13 Impact factor: 2.570