Parkinson’s Disease: Deep Brain Stimulation And Duodopa Pump
Parkinsons disease has a great impact on the physical and mental health that can lead to loss of autonomy and self-esteem, altered relationships, and social isolation . Furthermore, severely affected patients present a challenge to their families and health professionals. Two important current clinical treatments used to treat severe Parkinsons disease are deep brain stimulation and the Duodopa pump. Deep brain stimulation is a brain modulation technique that works like a pacemaker for the brain. It is a neurosurgical treatment because it requires the implant of electrodes deep inside the brain. These electrodes are connected by subcutaneous cables to a battery located in the chest. The battery sends electrical pulses to the electrodes, which can stimulate the brain and relieve the symptoms of Parkinsons disease. The duodopa pump consists of a continuous intrajunal infusion of levodopa-carbidopa intestinal gel. The gel is contained in a plastic cassette that is connected to a pump, which is connected to a tube inserted into the intestine through a small incision in the intestinal wall.
New Treatment Provides Freedom For Patient
Two advocates of Duopa are Parkinsons patient George Connors and his wife, Kay, of Randleman, North Carolina.
Among the first participants in the clinical trial at Wake Forest Baptist, he has been taking Duopa for more than 5 years now.
Its been a lifesaver, his wife said. It has made it easier for him to get up and do things.
Kay said the unreliable action of levodopa pills made it difficult for her husband to pursue activities he loved. But with Duopa, she said, he goes fishing, mows the yard and does outside work, all without having to remember when to take the pills.
George gave one example of how Duopa works better for him than pills. He said it used to take him as much as an hour each morning to stand up properly because his toes would cramp overnight and the levodopa pills were slow to work. With the Duopa pump system, he said, his toe cramps are gone within minutes.
Siddiqui said that new drugs and new delivery methods for existing drugs can relieve many of the symptoms experienced by people with Parkinsons and that ongoing research holds hope for the future.
Out of all the neurological diseases, we are finding Parkinsons to have more and more treatments available, he said.
Parkinson’s Foundation Center Of Excellence
At The University of Kansas Health System, our movement disorder specialists offer expert advice and state-of-the-art therapies for Parkinson’s disease and other movement disorders.
Dr. Pahwa told Sue about an FDA-approved levodopa delivery system called the Duopa infusion pump. Levodopa is the gold standard for the treatment of Parkinson’s disease, but the oral form often leads to fluctuations between good and poor control of symptoms. Duopa allows for continuous infusion of levodopa with the goal of increasing on time and reducing off time.
During an outpatient surgery, a small opening is made in the stomach wall and a tube is inserted into the small intestine. An electronic device, worn outside the body, pumps levodopa directly into the small intestine.
In May 2017, Sue decided to take the leap. “At first, it sounded kind of scary,” she says. “But once I had the pump, I wished I had done it as soon as they came out with it.”
Rather than taking a pill every hour, Sue now pops in a cassette filled with gel medicine twice a day. It provides a steady, continuous flow of levodopa day and night.
Before the Duopa pump, Sue worried she might have to move to an assisted living facility. “My family works, so they can’t take care of me all day long,” she explains.
But now, Sue can take care of herself. She can get out of bed on her own. She can do her own laundry. She can get around safely inside her home without a walker or cane.
How Duopa Is Administered
You should use Duopa according to your doctors or another healthcare professionals instructions.
To see if Duopa is right for you, you may first receive the drug through a tube in your nose that runs to your intestine.* If Duopa is effective, you can then receive the medication through a tube in your stomach that goes to your intestine.
For the drug to be given directly into your intestine, a stoma will need to be created. A stoma is a small hole made in your stomach. A pump that delivers Duopa attaches to a tube in the stoma. You or your caregiver will be trained on how to use Duopa with a pump.
Duopa comes as a liquid suspension thats in a cassette. The cassette attaches to the pump to deliver the drug as an infusion. An infusion is a liquid medication thats given to the body over a certain amount of time. Duopa is typically given over a 16-hour period.
You should take the Duopa cassette out of the refrigerator 20 minutes before you put it in the pump. This allows the drug to come to room temperature. You shouldnt use Duopa if the medication has been out of the refrigerator for longer than 16 hours.
For more information and a step-by-step guide on how to use Duopa, see the drugs instructions for use.
* The nasal tube is also called a naso-jejunal tube. The tube that enters your intestine through your stomach is also known as a jejunal tube .
Important Information About All Medicines
If you buy any medicines check with a pharmacist that they are safe to take with your other medicines.
Never take more than the prescribed dose. If you suspect that you or someone else might have taken an overdose of this medicine, go to the accident and emergency department of your local hospital. Take the container with you, even if it is empty.
This medicine is for you. Never give it to other people even if their condition appears to be the same as yours.
Do not keep out-of-date or unwanted medicines. Take them to your local pharmacy which will dispose of them for you.
If you have any questions about this medicine ask your pharmacist.
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Effectiveness For Parkinsons Disease
In clinical studies involving adults with advanced PD, Duopa was shown to be an effective treatment in easing motor fluctuations. For Duopa clinical study results, see the drugs prescribing information.
The International Parkinson and Movement Disorder Society recommends the active drugs in Duopa as a treatment for PD and PD-related symptoms.
New Tiny Implanted Pumps Can Inject Drugs Directly Into Brains
Scientists at Massachusetts Institute of Technology have developed a radical new way to treat neurodegenerative disorders like Parkinsonâs disease, and it sounds pretty freaking sci-fi. Their procedure involves implanting a thin probe connected to a tiny pump into a patientâs brain that delivers precisely measured and targeted drugs to specific brain areas. While this brain implant pump is a long way off from being installed in human patients, it has shown promise in an initial study in laboratory animals, treating Parkinsonâs-like symptoms in lab rats and monkeys.
The MIT researchers published their findings in a paper on Wednesday in the journal Science Translational Medicine. The main idea behind their device, called a âminiaturized neural drug delivery systemâ , is that it can precisely treat specific clusters of neurons without causing side effects. This improves upon previous methods that introduce drugs into the cerebrospinal fluid, which can also cause off-target effects.
One of the major advantages of the brain implants, the studyâs authors write, is that it allows doctors to target highly specific functional areas of the brain as small as one cubic millimeter â about the height and length of one letter on the U.S. penny. Not only that, but they can actually measure the activity of neurons in the area being treated, enabling them to monitor a drugâs effects and alter drug delivery in real time.
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Traditional Treatment Of Parkinsons Disease
The levodopa in pills is absorbed in the blood from the small intestine and travels through the bloodstream to the brain, where it is converted into dopamine and stored in neurons.
In the initial stages of Parkinsons, the brain still has some neurons capable of producing and storing dopamine. The levodopa pills which usually contain a drug called carbidopa to reduce nausea and other side effects give the brain a boost to ensure a sufficient supply of dopamine, thus promoting normal motor control.
But during the diseases more advanced stages, there arent enough neurons left to produce or store enough dopamine. As a result, patients must take more and more levodopa pills in order to supply the brain with adequate levels. At the same time, Parkinsons causes stomach functions to become slow and unpredictable, which can delay or even prevent the medicine in the pills from leaving the stomach and reaching the bloodstream in the small intestine. Consequently, later-stage Parkinsons patients are subject to more frequent and more pronounced motor fluctuations.
What Happens With Parkinsons Disease
PD is a type of movement disorder that affects your nervous system. In people with PD, the brain cells that make dopamine* stop working as well as usual or die. This causes low levels of dopamine in the brain. Over time, this loss of dopamine affects your control over your body movements.
* Dopamine is a brain chemical that sends messages to your body to help control your movements.
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Should I Wear My Duopa Pump While Im In The Shower Or Bath
No. You shouldnt wear your Duopa pump in the shower or bath.
When you take a shower or bath, youll need to do the following:
- Stop the continuous rate on your pump.
- Turn off your pump.
- Clamp your cassette tube and disconnect the tube.
- Replace the red cap on the tube.
For more details, see the drugs instructions for use.
You may need to take carbidopa/levodopa tablets if you disconnect your pump for a certain period of time, typically 2 hours or longer. Your doctor will tell you the specific amount of time that you can be disconnected before you need an oral dosage of the drugs.
If you have any questions about using your Duopa pump, talk with your doctor or pharmacist.
Duopa For Parkinsons Disease
The Food and Drug Administration approves prescription drugs such as Duopa to treat certain conditions.
Duopa is FDA-approved to treat advanced Parkinsons disease in adults who are experiencing motor fluctuations. These fluctuations occur when nerve cells can no longer control certain body movements.
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A Different Way To Deliver Levodopa
Duopa is a combination of carbidopa and levodopa in a suspension form that is delivered directly into the intestines by a pump for up to 16 hours. Duopa bypasses the stomach and delivers a continuous infusion of carbidopa-levodopa into the duodenum of the intestines, which often reduces or eliminates the fluctuations for many patients.
With Duopa, a procedure is required to make a small hole in the wall of the stomach to place a PEG-J tube for delivery of the carbidopa/levodopa suspension. PEG stands for percutaneous endoscopic gastrostomy, and the J stands for jejunal, the upper part of the small intestines. The PEG-J tube is connected to a cassette containing Duopa and a pump, which moves the medicine from the cassette through the tube.2
Once the PEG-J tube is in place, the patient can connect to a cassette of Duopa each morning and receive a continuous dose of carbidopa/levodopa for 16 hours. The tube is flushed at night, and other medications may be taken for PD symptoms at night.2
However, Duopa isnt right for everyone. Its important to weigh the benefits and risks and discuss your options with a neurologist, particularly a movement disorders specialist who is specially trained in understanding how different drugs can affect a PD patient.
What Other Information Should I Know
Keep all appointments with your doctor and the laboratory. Your doctor will order certain lab tests to check your response to levodopa and carbidopa.
Before having any laboratory test, tell your doctor and the laboratory personnel that you are taking levodopa and carbidopa.
Levodopa and carbidopa can lose its effect completely over time or only at certain times during the day. Call your doctor if your Parkinson’s disease symptoms worsen or vary in severity.
As your condition improves and it is easier for you to move, be careful not to overdo physical activities. Increase your activity gradually to avoid falls and injuries.
Levodopa and carbidopa can cause false results in urine tests for sugar and ketones .
Do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your prescription
It is important for you to keep a written list of all of the prescription and nonprescription medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.
Can Apomorphine Cause Problems
Along with their useful effects, most medicines can cause unwanted side-effects although not everyone experiences them. The table below contains some of the most common ones associated with apomorphine. You will find a full list in the manufacturers information leaflet supplied with your medicine. The unwanted effects often improve as your body adjusts to the new medicine, but speak with your doctor or pharmacist if any of the following continue or become troublesome.
|Common apomorphine side-effects|
|Stand up slowly and get your balance before you start to walk|
|Yawning, confusion, imagining things that are not real||If any of these become troublesome, speak with your doctor|
Important: speak with your doctor as soon as possible if you notice any of the following:
- Changes in your behaviour, such as a desire to gamble or an increased sex drive.
- Falling asleep suddenly.
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Duopa And Herbs And Supplements
Duopa may interact with supplements that contain iron. This can include some multivitamins.
Taking Duopa with supplements containing iron may decrease the level of levodopa your body absorbs. This can make Duopa less effective in treating your symptoms.
If you need to take a supplement that contains iron while youre using Duopa, talk with your doctor or pharmacist. They can advise you on the best time to take each treatment.
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A Duodopa Pump Changed My Life
A Duodopa pump is suitable for a small number of people whose Parkinsons symptoms can no longer be controlled with more common drug treatments, such as levodopa tablets.
Gio* had a Duodopa pump fitted recently and describes her experience.
Id been living with Parkinsons for more than a decade when I found that treatment with levodopa was no longer working well enough to control my worsening symptoms.
I first heard about the Duodopa pump some 6 years ago from a Parkinsons nurse, who spoke positively about it. My reaction was, What a rigmarole, no way! But as circumstances change, so do perspectives.
I was suffering from severe motor fluctuations that could no longer be controlled by tweaking the timing or dose of medication.
New Pump Helps Man Battle Parkinson’s
AMHERST, Wis. Eight-month-old Audrey Hurda smiled and grabbed the bill of her dads Caterpillar hat as he bent to give her a kiss.
Her dad, Tim, 38, has lived with Parkinsons disease for eight years and late this summer started a recently approved treatment, Duopa, aimed at helping control the symptoms of the degenerative disease.
Hurda did it for Audrey and his wife, Holly.
He underwent surgery in August to implant a tube in his digestive tract connected to a small external pump. The treatment is designed to provide patients with a more consistent flow of medications intended to help control disease symptoms including difficulty walking, stiffness, shaking, and slow movements.
Thats the main reason I did it, because of Audrey, Hurda said. Holly cant do everything herself, and I want to be functional enough to be able to play with her, raise her, pick her up from daycare, and feed her. Thats pretty much exactly what I got with this pump.
The pump, a square device about the size of a small paperback book, delivers medication directly to Hurdas small intestine via a tube implanted in his abdomen. The treatment, sold by AbbVie, was approved by the Federal Drug Administration in January.
While theres treatment for Parkinsons, there is no cure.
Hurda is one of two people in Wisconsin using the pump the other recipient was involved in clinical trials of the device according to AbbVie.
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Duopa Infusion Pump Gives Sue Gudde Better Symptom Control And Quality Of Life
Sue Gudde worked 19 years as a cook at a senior living community in Lee’s Summit, Missouri. She relied on her hands to chop, flip, scoop and serve. At age 50, she began to experience tremors on her left side, making job-related tasks more dangerous. Then she lost her sense of smell.
That’s when Sue was diagnosed with Parkinson’s disease. One year later, she found neurologist Rajesh Pahwa, MD, director of the Parkinson’s disease and movement disorder center, a Parkinson’s Foundation Center of Excellence, at The University of Kansas Health System in Kansas City.
“He’s the second doctor I went to about Parkinson’s and I’ve stuck with him for 14 years,” says Sue, now 65. “That’s how much I like him and the way he works. He’s one of the top in the world.”