Duodopa

Our study is an open, retrospective observation of the medical records of all of the patients who received LCIG (Duodopa^®, Abbott Laboratories) continuous infusion therapy via percutaneous endoscopic gastrojejunostomy (PEG/J) by means of a device (CADD-legacy-Duodopa-pump, Smiths Medical, MN, USA) at nine neurology centers in Romania (three centers in Bucharest, two centers in Cluj and one center in each of Oradea, Targu Mures, Iasi and Timisoara) from 1 January 2009 until the 30 September 2013. The data collection was approved by the local ethics committee of each center. All of the patients underwent a naso-jejunal test to evaluate their response to continuous administration of LCIG, and they were considered to be good responders.

In CLI, a levodopa-gel is continuously administered through a tube in the jejunum (Duodopa, Abbott, Abbott Park, IL, USA). The CLI-gel is dispensed into cassettes connected to an ambulatory programmable pump that delivers the suspension. One cassette supplies 100 ml gel containing 2000 mg levodopa and 500 mg carbidopa that lasts on average 16 h, depending on the individual needs. In some centres, a temporary nasoduodenal tube is used to assess whether the patient responds favorably to continuous levodopa infusion on day 1 to 3. On day 1 or 4 (depending on whether a temporary nasoduodenal tube is used first), a gastroenterologist endoscopically places a PEG tube in the stomach with an extension tube clipped in the jejunum using local anesthetic and sedation with a short acting benzodiazepine. If endoscopic placement fails, a radiologically placed jejunostomy may be performed. The tube is connected to the pump. Thereafter, CLI will immediately be initiated or continued and subsequently adjusted during the hospitalization of, generally, five days. Hereafter, patients will regularly visit the outpatient clinic to further adjust the dose.