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Polyneuropathy while on duodenal levodopa infusion in Parkinson's disease patients: We must be alert

AuthorsSantos-García, Diego; Carrillo, Fátima; Casanovas, Jordi; Mir, Pablo
Issue Date2012
CitationJournal of Neurology 259(8): 1668-1672 (2012)
AbstractSome reports have emerged describing the occurrence of Guillain- Barré syndrome and polyneuropathy related to vitamin B 12 deficiency in some patients with Parkinson's disease (PD) treated with continuous duodenal levodopa infusion. We describe five PD patients who developed axonal polyneuropathy and vitamin B 12 deficiency while on treatment with duodenal levodopa infusion, review other cases reported in the literature, discuss potential etiologic factors, and suggest a possible algorithm for the management and prevention of this complication. One case of Guillain-Barré syndrome and at least 12 cases of polyneuropathy related to vitamin B 12 deficiency have been reported in PD patients treated with duodenal levodopa infusion. Levodopa gel infusion may induce a decrease in vitamin B 12 levels, leading to peripheral neuropathy. Additional pathogenetic mechanisms include alterations related to the metabolism of L-dopa, abnormal L-dopa absorption, and direct neurotoxicity of L-dopa at high doses. Vitamin B 12 supplementation may need to be considered in PD patients on duodenal levodopa infusion therapy. Vitamin B 12 deficiency in patients on duodenal levodopa infusion therapy may be more frequent than the published data suggest. We must be alert. © Springer-Verlag 2012.
Identifiersdoi: 10.1007/s00415-011-6396-z
issn: 0340-5354
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