Intrajejunal levodopa infusion therapy for Parkinson’s disease: practical and pragmatic tips for successful maintenance of therapy

ABSTRACT

Introduction: Intrajejunal levodopa infusion (IJLI) therapy is one of the most influential therapies in moderate to late stage Parkinson’s disease with documented effects on motor and nonmotor symptoms and quality of life. The process of initiation and maintenance of therapy however, remains a challenge particularly in the long term.

Areas covered: The authors reviewed ‘evidence base’ for pathways and advice given to patients pre and post IJLI initiation. The authors found lack of patient, carer and clinician led ‘real life’ advisory documents which need to be given to patients on IJLI.

Expert commentary: Experience from centers engaged in IJLI therapy as well as feedback from carers and patients on IJLI suggest wide variability of practical advice given to patients. This is important as such tips could avoid termination of treatment or serious adverse events in some cases. In this review the authors provide a collection of pragmatic and practical tips for patients initiated on IJLI, both related to the short and long term and which we believe is a key unmet need. The paper is illustrated with two case reports.

KEYWORDS:

• Intrajejunal levodopa infusion
• pain
• practical tips
• procedural complications
• weight loss
• polyneuropathy

Acknowledgments

The authors acknowledge the support and advice from the IJLI team at Kings infusion program team and in particular Sally Trump, the IJLI nurse, and Sarah Hoey, the infusion and endoscopy nurse specialist and Dr Patrick Dubois, expert gastroenterologist. The authors also acknowledge the expert and valuable advice and tips provided by Mr Jon Hiseman, caregiver and husband of patient BT.

Declaration of Interest

N. Titova discloses honorarium for academic lectures at sponsored symposium from Teva, Torrent, and Abbvie Phramaceuticals, and has acted as an advisor for Teva. K.R. Chaudhuri discloses consultancies: Britannia, AbbVie, Neuronova, Mundipharma, UCB; advisory boards: Britannia, AbbVie, Neuronova, Mundipharma, UCB, Synapsus, Medtronics; honoraria lectures in symposium: Boehringer Ingelheim, GSK Pharamaceuticals, AbbVie, Britannia, UCB, Mundipharma, Otsuka, Zambon; grants: Boehringer Ingelheim, GSK Pharamaceuticals, Britania Pharmaceuticals, AbbVie, UCB, Neuronova; academic: EU, Parkinson’s UK, NIHR, PDNMG, Intellectual Property Rights KPP scale, PDSS-2. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Additional information

Funding

This paper was not funded.