Everything I need to know about Duodopa and continuous dopamine pumps for Parkinson's disease

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

To read more books and articles by Michael S. Okun MD check Twitter @MichaelOkun and these websites with blogs and information on his books and http://parkinsonsecrets.com/ #EndingPD and https://www.tourettetreatment.com/