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Outcome prediction of enteral levodopa/carbidopa infusion in advanced Parkinson's disease
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Biomedical Informatics and Engineering.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Biomedical Informatics and Engineering.
Dalarna University.
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2006 (English)In: Parkinsonism & Related Disorders, ISSN 1353-8020, E-ISSN 1873-5126, Vol. 12, no 8, 509-513 p.Article in journal (Refereed) Published
Abstract [en]

Two studies comparing intraduodenal infusion of a levodopa/carbidopa gel with oral treatments in advanced PD patients demonstrated improvement in UPDRS scores and in frequent clinical ratings on a global treatment response scale. Further analysis of data from these studies was performed to find predictive factors related to degree of improvement with infusion. Pearson's correlation coefficients between measures of improvement and baseline variables were calculated. Using data from one study, a prediction model was designed and was then evaluated using the other study's data. Correlations were found indicating that patients with more severe symptoms at baseline were most improved after infusion.

Place, publisher, year, edition, pages
2006. Vol. 12, no 8, 509-513 p.
Keyword [en]
Continuous dopaminergic stimulation, Improvement measure, Levodopa infusion, Outcome prediction, Parkinson's disease, Predictive factor
National Category
Medical and Health Sciences
Research subject
Medical Informatics; Neurology
URN: urn:nbn:se:uu:diva-21768DOI: 10.1016/j.parkreldis.2006.02.006ISI: 000243285100008PubMedID: 16731025OAI: oai:DiVA.org:uu-21768DiVA: diva2:49541
Available from: 2007-01-04 Created: 2007-01-04 Last updated: 2011-02-17Bibliographically approved
In thesis
1. Decision Support for Treatment of Patients with Advanced Parkinson’s Disease
Open this publication in new window or tab >>Decision Support for Treatment of Patients with Advanced Parkinson’s Disease
2010 (English)Doctoral thesis, comprehensive summary (Other academic)
Alternative title[sv]
Beslutsstöd för behandling av patienter med avancerad Parkinsons sjukdom
Abstract [en]

The overall aim of this thesis was to develop, deploy and evaluate new IT-based methods for supporting treatment and assessment of treatment of advanced Parkinson’s disease. In this condition a number of different motor and non-motor symptoms occur in episodes of varying frequency, duration and severity. In order to determine outcome of treatment changes, repeated assessments are necessary. Hospitalization for observation is expensive and may not be representative for the situation at home. Paper home diaries have questionable reliability and storage and retrieval of results are problematic. Approaches for monitoring using wearable sensors are unable to address important non-motor symptoms.

A test battery system consisting of both self-assessments of symptoms and motor function tests was constructed for a touch screen mobile phone. Tests are performed on several occasions per day during test periods of one week. Data is transmitted over the mobile net to a central server where summaries in different symptom dimensions and an overall test score per patient and test period are calculated. There is a web application that graphically presents the results to treating clinical staff. As part of this work, a novel method for assessment of spiral drawing impairment useful during event-driven sampling was developed. To date, the system has been used by over 100 patients in 10 clinics in Sweden and Italy. Evidence is growing that the test battery is useful, reliable and valid for assessment of symptoms during advanced Parkinson’s disease.

Infusion of a levodopa/carbidopa gel into the small intestine has been shown to reduce variation in plasma drug levels and improve clinical response in this patient category. A pharmacokinetic-pharmacodynamic model of this intestinal gel infusion was constructed. Possibly this model can assist the process of individualization of dosage for this treatment through in numero simulations. Results from an exploratory data analysis indicate that severity measures during oral levodopa treatment may be factors to consider when deciding candidates for infusion treatment.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2010. 76 p.
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 621
Parkinson’s disease, telemedicine, motor test, tapping, spiral, self-assessment, home-assessment, outcome measure, electronic diary, patient-reported outcome, remote patient monitoring, levodopa, infusion, pharmacokinetic, pharmacodynamic
National Category
Biomedical Laboratory Science/Technology
Research subject
Medical Informatics
urn:nbn:se:uu:diva-132635 (URN)978-91-554-7947-3 (ISBN)
Public defence
2010-12-18, Rudbecksalen, Rudbecklaboratoriet, Dag Hammarskjölds väg 20, Uppsala, 13:00 (Swedish)
Available from: 2010-11-26 Created: 2010-10-23 Last updated: 2011-01-13Bibliographically approved

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Westin, JerkerNyholm, DagGroth, Torgny
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Biomedical Informatics and EngineeringDepartment of Neuroscience
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