The Dream of a Pill Free Existence and the Continuous Dopaminergic Pump for the Treatment of Parkinson’s Disease
Could there be a pill free existence with Parkinson's disease? Enter the dopamine pump technology....
How does it work?
- A strategy that offers the possibility of constant stimulation of the brain’s dopamine receptors through the use of a continuous dopamine infusion pump technology.
- A recent trial was published in Lancet Neurology.
-The trial utilized an intrajejunal (i.e. a tube inserted in the small intestine) levodopa-carbidopa intestinal gel pump infusion strategy, and it was designed to collect safety and effectiveness data
- The study was double blind (neither the patients nor the raters knew what was administered) and randomized.
- The article reveals that participants were randomized (1:1) to “immediate-release oral levodopa-carbidopa pills plus a placebo intestinal gel infusion or to levodopa-carbidopa intestinal gel infusion plus oral placebo pills.” It is important to remember that everyone in the study received a pump, but half of the patients did not receive active therapy (through the continuous pump infusion).
- Off-time improved by 4 hours in the pump group versus 2.1 hours in the pill group
- "On” time without troublesome dyskinesia was better in the pump group when compared to the pill group
- The pump is approved and available in 43 countries but not yet in the USA
- The study did not enroll patients with severe dyskinesia, and we still don't know the exact profile for the best pump patients
- The gatrojejunostomy (small feeding tube) presents the biggest challenges and complications
- Complications with the tube and hardware were present in 89% of subjects but were mostly addressable
- The pump requires wearing an external device, and it also requires changing a dopamine cassette once or twice a day
- Some will need additional medications during the bedtime hours.
- Pumps require continuous maintenance and programming
- An important next step will be a comparison to deep brain stimulation
- Pumps are exciting but not cures
For more detailed information read Dr. Okun's monthly what's hot in Parkinson's disease column on the NPF website.