Prevalence and features of peripheral neuropathy in Parkinson's disease patients under different therapeutic regimens

F. Mancini, C. Comi, G. D. Oggioni, C. Pacchetti, D. Calandrella, M. Coletti Moja, G. Riboldazzi, S. Tunesi, M. Dal Fante, L. Manfredi, M. Lacerenza, R. Cantello, A. Antonini

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Abstract

Background: Recent reports suggest increased frequency of peripheral neuropathy (PN) in Parkinson's disease (PD) patients on levodopa compared with age-matched controls particularly during continuous levodopa delivery by intestinal infusion (CLDII). The aim of this study is to compare frequency, clinical features, and outcome of PN in PD patients undergoing different therapeutic regimens. Methods: Three groups of consecutive PD patients, 50 on intestinal levodopa (CLDII), 50 on oral levodopa (O-LD) and 50 on other dopaminergic treatment (ODT), were enrolled in this study to assess frequency of PN using clinical and neurophysiological parameters. A biochemical study of all PN patients was performed. Results: Frequency of PN of no evident cause was 28% in CLDII, 20% in O-LD, and 6% in ODT patients. Clinically, 71% of CLDII patients and all O-LD and ODT PN patients displayed a subacute sensory PN. In contrast, 29% of CLDII patients presented acute motor PN. Levodopa daily dose, vitamin B12 (VB12) and homocysteine (hcy) levels differed significantly in patients with PN compared to patients without PN. Conclusions: Our findings support the relationship between levodopa and PN and confirm that an imbalance in VB12/hcy may be a key pathogenic factor. We suggest two different, possibly overlapping mechanisms of PN in patients on CDLII: axonal degeneration due to vitamin deficiency and inflammatory damage. Whether inflammatory damage is triggered by vitamin deficiency and/or by modifications in the intestinal micro-environment should be further explored. Proper vitamin supplementation may prevent peripheral damage in most cases.

Original languageEnglish
Pages (from-to)27-31
Number of pages5
JournalParkinsonism and Related Disorders
Volume20
Issue number1
DOIs
Publication statusPublished - Jan 2014

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Levodopa
Peripheral Nervous System Diseases
Parkinson Disease
Therapeutics
Avitaminosis
Homocysteine
Vitamin B 12
Vitamins

Keywords

  • Levodopa intestinal infusion
  • Neuropathy
  • Parkinson's disease

ASJC Scopus subject areas

  • Geriatrics and Gerontology
  • Clinical Neurology
  • Neurology

Cite this

Prevalence and features of peripheral neuropathy in Parkinson's disease patients under different therapeutic regimens. / Mancini, F.; Comi, C.; Oggioni, G. D.; Pacchetti, C.; Calandrella, D.; Coletti Moja, M.; Riboldazzi, G.; Tunesi, S.; Dal Fante, M.; Manfredi, L.; Lacerenza, M.; Cantello, R.; Antonini, A.

In: Parkinsonism and Related Disorders, Vol. 20, No. 1, 01.2014, p. 27-31.

Research output: Contribution to journalArticle

Mancini, F, Comi, C, Oggioni, GD, Pacchetti, C, Calandrella, D, Coletti Moja, M, Riboldazzi, G, Tunesi, S, Dal Fante, M, Manfredi, L, Lacerenza, M, Cantello, R & Antonini, A 2014, 'Prevalence and features of peripheral neuropathy in Parkinson's disease patients under different therapeutic regimens', Parkinsonism and Related Disorders, vol. 20, no. 1, pp. 27-31. https://doi.org/10.1016/j.parkreldis.2013.09.007
Mancini, F. ; Comi, C. ; Oggioni, G. D. ; Pacchetti, C. ; Calandrella, D. ; Coletti Moja, M. ; Riboldazzi, G. ; Tunesi, S. ; Dal Fante, M. ; Manfredi, L. ; Lacerenza, M. ; Cantello, R. ; Antonini, A. / Prevalence and features of peripheral neuropathy in Parkinson's disease patients under different therapeutic regimens. In: Parkinsonism and Related Disorders. 2014 ; Vol. 20, No. 1. pp. 27-31.
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AU - Comi, C.

AU - Oggioni, G. D.

AU - Pacchetti, C.

AU - Calandrella, D.

AU - Coletti Moja, M.

AU - Riboldazzi, G.

AU - Tunesi, S.

AU - Dal Fante, M.

AU - Manfredi, L.

AU - Lacerenza, M.

AU - Cantello, R.

AU - Antonini, A.

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N2 - Background: Recent reports suggest increased frequency of peripheral neuropathy (PN) in Parkinson's disease (PD) patients on levodopa compared with age-matched controls particularly during continuous levodopa delivery by intestinal infusion (CLDII). The aim of this study is to compare frequency, clinical features, and outcome of PN in PD patients undergoing different therapeutic regimens. Methods: Three groups of consecutive PD patients, 50 on intestinal levodopa (CLDII), 50 on oral levodopa (O-LD) and 50 on other dopaminergic treatment (ODT), were enrolled in this study to assess frequency of PN using clinical and neurophysiological parameters. A biochemical study of all PN patients was performed. Results: Frequency of PN of no evident cause was 28% in CLDII, 20% in O-LD, and 6% in ODT patients. Clinically, 71% of CLDII patients and all O-LD and ODT PN patients displayed a subacute sensory PN. In contrast, 29% of CLDII patients presented acute motor PN. Levodopa daily dose, vitamin B12 (VB12) and homocysteine (hcy) levels differed significantly in patients with PN compared to patients without PN. Conclusions: Our findings support the relationship between levodopa and PN and confirm that an imbalance in VB12/hcy may be a key pathogenic factor. We suggest two different, possibly overlapping mechanisms of PN in patients on CDLII: axonal degeneration due to vitamin deficiency and inflammatory damage. Whether inflammatory damage is triggered by vitamin deficiency and/or by modifications in the intestinal micro-environment should be further explored. Proper vitamin supplementation may prevent peripheral damage in most cases.

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