What can we learn from the effect of trihexyphenidyl on motor fluctuations during continuous levodopa-carbidopa intestinal gel infusion (LCIG)? – First documented case
Motor fluctuations can be seen even during treatment with continuous levodopa-carbidopa intestinal gel infusion (LCIG). We report on a middle-aged man with advanced Parkinson's disease (PD) on LCIG in which motor fluctuations have been improved with an anticholinergic. To the best of our knowle...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2020-01-01
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| Series: | Clinical Parkinsonism & Related Disorders |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2590112520300396 |
| _version_ | 1818622689808482304 |
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| author | Shin-ichiro Kubo Ken Nakamura Yoshimasa Tada Nobuyuki Kashio Shinya Yamashita |
| author_facet | Shin-ichiro Kubo Ken Nakamura Yoshimasa Tada Nobuyuki Kashio Shinya Yamashita |
| author_sort | Shin-ichiro Kubo |
| collection | DOAJ |
| description | Motor fluctuations can be seen even during treatment with continuous levodopa-carbidopa intestinal gel infusion (LCIG). We report on a middle-aged man with advanced Parkinson's disease (PD) on LCIG in which motor fluctuations have been improved with an anticholinergic. To the best of our knowledge, there have been no previous LCIG cases reported with motor fluctuations responding to non-dopaminergic agent, which might reveal some clues to its pathophysiology. Long-term oral levodopa treatment is associated with development of potentially disabling motor complications including motor fluctuations and dyskinesias in the majority of patients with PD. It has been suggested that motor complications are related to the nonphysiological restoration of brain dopamine with intermittent administration of standard oral levodopa. LCIG significantly reduces “off” time and increases “on” time without dyskinesia in comparison to standard oral levodopa through consistent plasma concentration of levodopa to restore brain dopamine in a more physiological manner. However, it has been reported that PD patients on LCIG often worsen during the afternoon hours, even with stable plasma concentration of levodopa. This raises the possibility that additional factors to dopamine deficiency could play a role in occurrence of motor fluctuations. Here we offer a hypothesis that altered cholinergic signaling could also be involved in the pathophysiology of motor fluctuations, based on our clinical evidence that anticholinergic drug has eliminated motor fluctuations during LCIG in a patient with PD. Further studies for non-dopaminergic along with dopaminergic signaling may be needed to better understand the pathophysiological basis of motor complications in PD. |
| first_indexed | 2024-12-16T18:29:10Z |
| format | Article |
| id | doaj.art-9864f5d858644a5488e41374d46b4ca8 |
| institution | Directory Open Access Journal |
| issn | 2590-1125 |
| language | English |
| last_indexed | 2024-12-16T18:29:10Z |
| publishDate | 2020-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Clinical Parkinsonism & Related Disorders |
| spelling | doaj.art-9864f5d858644a5488e41374d46b4ca82022-12-21T22:21:21ZengElsevierClinical Parkinsonism & Related Disorders2590-11252020-01-013100071What can we learn from the effect of trihexyphenidyl on motor fluctuations during continuous levodopa-carbidopa intestinal gel infusion (LCIG)? – First documented caseShin-ichiro Kubo0Ken Nakamura1Yoshimasa Tada2Nobuyuki Kashio3Shinya Yamashita4Department of Neurology, Eisei Hospital, Tokyo, Japan; Corresponding author at: 583-15 Kunugidamachi, Hachioji, Tokyo 193-0942, Japan.Department of Neurology, Eisei Hospital, Tokyo, JapanDepartment of Neurology, Eisei Hospital, Tokyo, JapanDepartment of Neurology, Eisei Hospital, Tokyo, JapanDepartment of Gastroenterology, Eisei Hospital, Tokyo, JapanMotor fluctuations can be seen even during treatment with continuous levodopa-carbidopa intestinal gel infusion (LCIG). We report on a middle-aged man with advanced Parkinson's disease (PD) on LCIG in which motor fluctuations have been improved with an anticholinergic. To the best of our knowledge, there have been no previous LCIG cases reported with motor fluctuations responding to non-dopaminergic agent, which might reveal some clues to its pathophysiology. Long-term oral levodopa treatment is associated with development of potentially disabling motor complications including motor fluctuations and dyskinesias in the majority of patients with PD. It has been suggested that motor complications are related to the nonphysiological restoration of brain dopamine with intermittent administration of standard oral levodopa. LCIG significantly reduces “off” time and increases “on” time without dyskinesia in comparison to standard oral levodopa through consistent plasma concentration of levodopa to restore brain dopamine in a more physiological manner. However, it has been reported that PD patients on LCIG often worsen during the afternoon hours, even with stable plasma concentration of levodopa. This raises the possibility that additional factors to dopamine deficiency could play a role in occurrence of motor fluctuations. Here we offer a hypothesis that altered cholinergic signaling could also be involved in the pathophysiology of motor fluctuations, based on our clinical evidence that anticholinergic drug has eliminated motor fluctuations during LCIG in a patient with PD. Further studies for non-dopaminergic along with dopaminergic signaling may be needed to better understand the pathophysiological basis of motor complications in PD.http://www.sciencedirect.com/science/article/pii/S2590112520300396Motor fluctuationsLCIGAfternoon offAnticholinergicsParkinson's disease |
| spellingShingle | Shin-ichiro Kubo Ken Nakamura Yoshimasa Tada Nobuyuki Kashio Shinya Yamashita What can we learn from the effect of trihexyphenidyl on motor fluctuations during continuous levodopa-carbidopa intestinal gel infusion (LCIG)? – First documented case Clinical Parkinsonism & Related Disorders Motor fluctuations LCIG Afternoon off Anticholinergics Parkinson's disease |
| title | What can we learn from the effect of trihexyphenidyl on motor fluctuations during continuous levodopa-carbidopa intestinal gel infusion (LCIG)? – First documented case |
| title_full | What can we learn from the effect of trihexyphenidyl on motor fluctuations during continuous levodopa-carbidopa intestinal gel infusion (LCIG)? – First documented case |
| title_fullStr | What can we learn from the effect of trihexyphenidyl on motor fluctuations during continuous levodopa-carbidopa intestinal gel infusion (LCIG)? – First documented case |
| title_full_unstemmed | What can we learn from the effect of trihexyphenidyl on motor fluctuations during continuous levodopa-carbidopa intestinal gel infusion (LCIG)? – First documented case |
| title_short | What can we learn from the effect of trihexyphenidyl on motor fluctuations during continuous levodopa-carbidopa intestinal gel infusion (LCIG)? – First documented case |
| title_sort | what can we learn from the effect of trihexyphenidyl on motor fluctuations during continuous levodopa carbidopa intestinal gel infusion lcig first documented case |
| topic | Motor fluctuations LCIG Afternoon off Anticholinergics Parkinson's disease |
| url | http://www.sciencedirect.com/science/article/pii/S2590112520300396 |
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