Continuous L-dopa delivery useful for Parkinson's
Thu Jun 16, 2005 08:39 AM ET
By Karla Gale
NEW YORK (Reuters Health) - Giving the anti-Parkinson's drug levodopa
continuously through a naso-gastric tube is better than the pill form of
the drug at reducing the movement problems seen with the disease, according
to a report in the Archives of Neurology.
With the continuous approach, a narrow tube is inserted through the nose
and then advanced into the intestine under x-ray guidance. Once in
position, a small amount of liquid levodopa is pumped into the intestine on
a continuous basis.
This infusion method of delivering levodopa is thought to work better than
simply taking a pill because drug levels in the body don't fluctuate as
much. With a pill, the periodic rise and drop in drug levels can actually
have a damaging effect on nerve cells and lead to permanent movement problems.
"Levodopa-induced (movement problems) are the major reason why patients
have surgery for Parkinson's," Dr. C. Warren Olanow, from Mount Sinai
School of Medicine in New York, told Reuters Health. "What we're trying to
do is figure out how to prevent these adverse events so patients won't need
surgery."
In the present study, Olanow's group switched six patients with advanced
Parkinson's disease from levodopa pills to naso-gastric infusions of the
drug and then evaluated the effect on movement.
Changing to the infusions significantly reduced the movement problems seen
in the patients and improved their ability to perform routine activities of
daily living.
Unfortunately, the problem with infusions is that they're inconvenient,
Olanow noted. "What we want to do is figure out why infusion is better than
(pills)" and maybe then a way can be found to give levodopa that better
suits the body's physiology.
He theorizes that giving levodopa pills in combination with drugs called
COMT inhibitors may reproduce the benefits seen with infusion.
"We've shown that when monkeys take levodopa with the COMT inhibitor they
have less (movement problems) than if they take levodopa alone," Olanow
said. He and his associates are now in the planning stages of a large trial
to test this strategy in humans.
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