Advanced Therapies for Parkinson’s disease:
Deep brain stimulation (surgery) and infusion therapies such as levodopa-carbidopa intestinal gel (Duodopa) and apomorphine subcutaneous therapies are considered advanced therapies for people with Parkinson’s disease who have a good response to levodopa-carbidopa therapy but experience significant fluctuations including troublesome dyskinesias, predictable and/or unpredictable off episodes.
The neurology and movement disorder clinic (NMDC) has been designated a Centre of Excellence for Duodopa as an advanced therapy for Parkinson’s disease and it is currently the only approved site in the province of Manitoba.
The gel formulation of levodopa-carbidopa is administered as a continuous infusion via a tube placed in the small bowel called percutaneous endoscopic jejunal (PEJ) tube. This provides for a more consistent delivery and optimal absorption of this drug as it is delivered to the part of the small bowel that is responsible for the absorption of the drug. This results in less fluctuations which are both a result of a narrow therapeutic window associated with disease progression and delayed gastric emptying.
If you are a physician wishing to have you patient considered for Duodopa therapy, please send a referral to the clinic. If you are a patient and you would like to know whether you would potentially benefit from this therapy, please discuss this with you treating neurologist who would initiate the appropriate referral process if you are deemed to be a candidate.
This therapy is offered in collaboration with Dr. D. Duerksen, gastroenterologist, section of gastroenterology at St. Boniface Hospital Winnipeg (percutaneous endoscopic jejunal tube placement)