Liječenje parkinsonove bolesti primjenom levodope putem perkutane duodenostome

master's thesis

• Title (english): Levodopa treatment for parkinson's via percutaneous duodenostomy
• Author: Sara Jelić
• Mentor: Srđana Telarović (mentor)
• Committee member: Zdravka Poljaković (predsjednik povjerenstva)
• Committee member: Mario Habek (član povjerenstva)
• Committee member: Srđana Telarović (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Neurology); Zagreb
• Defense date and country: 2016-07-15, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Neurology

Abstract

Parkinsonova bolest (PB) je kronična neurodegenerativna bolest uzrokovana propadanjem dopaminergičnih neurona crne jezgre. Glavni simptomi bolesti, kao što su tremor prisutan u mirovanju, bradikineza i rigiditet, učinkovito se liječe supstitucijskom farmakoterapijom u ranoj fazi bolesti. Levodopa, u kombinaciji s perifernim inhibitorom dopa dekarboksilaze karbidopom, i dopaminski agonisti trenutno predstavljaju najučinkovitije liječenje PB. Međutim, tijekom vremena, u bolesnika na dugotrajnoj terapiji levodopom trajanje odgovora na terapiju postaje kraće te se pojavljuju motorne fluktuacije i diskinezije. Motoričke i nemotoričke komplikacije odraz su varijabilnih koncentracija lijeka u plazmi, koje nastaju zbog kratkog poluživota levodope i nepravilne apsorpcije lijeka zbog odgođenog pražnjenja želuca (nemotorički simptom PB). Kontinuirana infuzija levodopa/karbidopa intestinalnog gela (LCIG) izravno u duodenum rezultira značajnim smanjenjem motoričkih komplikacija redukcijom varijabilnih plazmatskih koncentracija levodope. Ovakav način primjene terapije koristan je za odabrane bolesnike s uznapredovalom PB kod kojih optimiziranom oralnom terapijom nije postignuta zadovoljavajuća kontrola bolesti. LCIG terapija se u obliku karboksimetilceluloznog gela u formi kazete isporučuje izravno u duodenum i proksimalni jejunum preko perkutane endoskopske duodenostome pomoću sonde koja je s vanjske strane priključena na prijenosnu infuzijsku pumpu. To omogućava individualno i kontinuirano oslobađanje lijeka na fiziološkom mjestu apsorpcije (jejunum). Primjenu, doziranje, programiranje i evaluaciju terapije vrši educirani specijalist neurolog te specijalizirana medicinska sestra (''PD nurse''). Prije postavljanja duodenostome, klinički odgovor na terapiju može se ispitati primjenom levodopa/karbidopa gela pomoću privremene nazojejunalne sonde. Primjena LCIG terapije zahtjeva multidisciplinaran pristup, pažljiv odabir i kontinuirano praćenje bolesnika.

Abstract (english)

Parkinson's disease (PD) is a neurodegenerative disorder associated with the loss of dopaminergic neurons in the substantia nigra. The cardinal symptoms of PD, rest tremor, bradykinesia and rigidity, are effectively treated with a combination of oral levodopa and dopamine agonists during the early phase of the disease. However, over time, in patients receiving long-term oral levodopa treatment the duration of the response becomes shorter and motor fluctuations and dyskinesia develop. Motor and non-motor symptom fluctuations reflect fluctuations in levodopa plasma concentrations resulting from the short half-life of levodopa and erratic absorption in relation to delayed gastric emptying (non-motor symptom of PD). Continuous infusion of levodopa/carbidopa intestinal gel (LCIG) directly into the small intestine of PD patients results in marked reduction of motor fluctuations by reducing levodopa plasma variability. LCIG treatment is an expedient offer for selected patients with advanced PD who have experienced unsatisfactory effect of oral treatment. LCIG is a carboxymethylcellulose gel delivered directly to the duodenum and proximal jejunum via percutaneous endoscopic duodenostomy by a tube connected to a portable infusion pump. It allows continuous release of the drug at the physiological site of absorption (jejunum). Application, dosage, programming and evaluation of therapy is induced by neurological specialist and nurse practitioner (“PD nurse“). The clinical response can be tested before establishing a duodenostomy, by temporary levodopa/carbidopa treatment through a naso-jejunal tube. The application of LCIG treatment requires a multidisciplinary approach, careful selection and continuous monitoring of patients.

• Keywords: Parkinsonova bolest; kontinuirana infuzija; levodopa/karbidopa gel; motoričke fluktuacije; diskinezije
• Keywords (english): Parkinson's disease; continuous infusion; levodopa/carbidopa gel; motor fluctuations; dyskinesia
• Language: croatian
• URN:NBN: urn:nbn:hr:105:701715
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2017-06-19 07:28:45