Intrajejunal levodopa infusion in Parkinson's disease: a pilot multicenter study of effects on nonmotor symptoms and quality of life

Mov Disord. 2009 Jul 30;24(10):1468-74. doi: 10.1002/mds.22596.


Switching from oral medications to continuous infusion of levodopa/carbidopa gel reduces motor complications in advanced Parkinson's disease (PD), but effects on nonmotor symptoms (NMSs) are unknown. In this prospective open-label observational study, we report the effects of intrajejunal levodopa/carbidopa gel infusion on NMS in PD based on standard assessments utilizing the nonmotor symptoms scale (NMSS) along with the unified Parkinson's disease rating scale (UPDRS 3 motor and 4 complications) and quality of life (QoL) using the Parkinson's disease questionnaire (PDQ-8). Twenty-two advanced PD patients (mean age 58.6 years, duration of disease 15.3 years) were followed for 6 months. A statistically significant beneficial effect was shown in six of the nine domains of the NMSS: cardiovascular, sleep/fatigue, attention/memory, gastrointestinal, urinary, and miscellaneous (including pain and dribbling) and for the total score of this scale (NMSST) paralleling improvement of motor symptoms (UPDRS 3 motor and 4 complications in "best on" state) and dyskinesias/motor fluctuations. In addition, significant improvements were found using the Parkinson's disease sleep scale (PDSS) and the PDQ-8 (QoL). The improvement in PDQ-8 scores correlated highly significantly with the changes in NMSST, whereas a moderately strong correlation was observed with UPDRS changes. This is the first demonstration that a levodopa-based continuous dopaminergic stimulation is beneficial for NMS and health-related quality of life in PD in addition to the reduction of motor fluctuations and dyskinesias.

Publication types

  • Clinical Trial
  • Multicenter Study

MeSH terms

  • Aged
  • Antiparkinson Agents / administration & dosage*
  • Disability Evaluation
  • Duodenum / drug effects*
  • Duodenum / physiology
  • Endoscopes, Gastrointestinal
  • Female
  • Humans
  • International Cooperation
  • Levodopa / administration & dosage*
  • Male
  • Middle Aged
  • Parkinson Disease* / drug therapy
  • Parkinson Disease* / physiopathology
  • Parkinson Disease* / psychology
  • Pilot Projects
  • Prospective Studies
  • Quality of Life / psychology*
  • Severity of Illness Index
  • Surveys and Questionnaires
  • Treatment Outcome


  • Antiparkinson Agents
  • Levodopa