Intrajejunal Levodopa Infusion Therapy for Parkinson's Disease

1. Intrajejunal Levodopa InfusionTherapy
for Parkinson’s Disease
AdeWijaya, MD – September 2019

2. Introduction
• Levodopa is the most potent and effective therapy to treat
Parkinson’s disease (PD)
• Chronic levodopa use leads to development of motor and
nonmotor fluctuations and dyskinesias that may arise from
intermittent pulsatile stimulation of striatal dopamine
receptors
• To counteract this challenge, continuous dopaminergic
stimulation or continuous drug delivery (CDD) is now used in
clinical practice
LeWitt P, Fahn S. Levodopa therapy for Parkinson disease: a look backward and forward. Neurology. 2016;86(14 Suppl 1):3–12.
Chaudhuri KR, Schapira AH. Non-motor symptoms of Parkinson’s disease: 1325 dopaminergic pathophysiology and treatment. Lancet Neurol. 2009;8(5):464–474.
Jenner P. From the MPTP-treated primate to the treatment of motor complications in Parkinson’s disease. Parkinsonism Relat Disord. 2009;15(4):18–23.
Olanow CW, Obeso JA, Stocchi F. Continuous dopamine-receptor treatment of Parkinson’s disease: scientific rationale and clinical implications. Lancet Neurol. 2006;5(8):677–687.

3. Intrajejunal Levodopa Infusion (IJLI)
• Levodopa–carbidopa intestinal gel
• Is a carboxymethylcellulose aqueous gel which is contained in
a portable infusion pump which enables delivery of levodopa
gel to the proximal duodenum in continuous fashion via a
percutaneous endoscopic gastrojejunostomy (PEG-J) tube.
• Was developed and launched first in Sweden in 2004
Titova N, Ray Chaudhuri K. Intrajejunal levodopa infusion therapy for Parkinson’s disease: Practical and pragmatic tips for successful maintenance of therapy. Expert review of neurotherapeutics. 2017 Jun 3;17(6):529-37.

5. Adverse Events
Olanow CW, Obeso JA, Stocchi F. Continuous dopamine-receptor treatment of Parkinson’s disease: scientific rationale and clinical implications. Lancet Neurol. 2006;5(8):677–687.

7. Titova N, Ray Chaudhuri K. Intrajejunal levodopa infusion therapy for Parkinson’s disease: Practical and pragmatic tips for successful maintenance of therapy. Expert review of neurotherapeutics. 2017 Jun 3;17(6):529-37.

8. Recommendations
• Identification bracelet
• Dietary advice
• Screen patients for blood vitamin B6, B12 and folate,
hemoglobin, and homocysteine levels
• Identify pain
• Weight loss often occurs as a delayed complication
Titova N, Ray Chaudhuri K. Intrajejunal levodopa infusion therapy for Parkinson’s disease: Practical and pragmatic tips for successful maintenance of therapy. Expert review of neurotherapeutics. 2017 Jun 3;17(6):529-37.

9. Recommendations
• In some patients, there may be abnormal weight gain or there may
be pre-existing obesity or diabetes mellitus  prone to infection 
monitoring of skin
• Identify vision or hearing problems
• IJLI is usually well tolerated with other therapies. However, the use
of catechol-О-methyltransferase (COMT) inhibitors may sometime
precipitate severe dyskinesias
• Polineuropathy
• A clear set of instructions regarding dose adjustment of IJLI
therapy is provided to health-care professionals
Titova N, Ray Chaudhuri K. Intrajejunal levodopa infusion therapy for Parkinson’s disease: Practical and pragmatic tips for successful maintenance of therapy. Expert review of neurotherapeutics. 2017 Jun 3;17(6):529-37.

10. Summary
• Intrajejunal levodopa infusion is an important part of advanced therapies
for Parkinson’s disease  improvement in quality of life
• High rates of procedure as well as nonprocedure related side effects
• Many of these side effects can be reduced or even avoided with good
quality pragmatic and real life advice and information given to patients
as well as health care professionals who continue to care for patients on
IJLI
• Dietary advice
• All patients should ideally be provided with a personalized plan
regarding IJLI therapy and tips to address some of these issues that may
complicate therapy

11. THANKYOU