Figura. Algoritmo de instauración y manejo ambulatorio del tratamiento con infusión intraduodenal de levodopa-carbidopa. HADO: hospitalización a domicilio; HdD: hospital de día de neurología; PEG: gastrostomía endoscópica percutánea.
Tabla I. Características de los pacientes. |
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Edad (años) |
Duración de la |
UPDRS III |
Levodopa |
APO |
Complicaciones en |
Meses de |
Flujo de la IILC matinal (mL)/ |
75 (mujer) |
9/4 |
26/44 |
1.200 |
136 |
Dolor local |
20 |
15/5 |
75 (mujer) |
7/3 |
33/49 |
1.250 |
32 |
Dolor local, mínimo sangrado estomal |
15 |
7,5/4 |
71 (varón) |
5/2 |
23/51 |
1.125 |
88 |
No |
8 |
8/6,4 |
75 (mujer) |
13/3 |
35/58 |
1.000 |
No |
No |
6 |
9/1,6 |
78 (mujer) |
7/3 |
22/39 |
1.250 |
No |
No |
6 |
9/4,4 |
APO: infusión continua de apomorfina subcutánea; EP: enfermedad de Parkinson; IILC: infusión intraduodenal de levodopa-carbidopa; UPDRS: Unified Parkinson’s Disease Rating Scale. |
Tabla II. Estimación del coste económico de ambos modelos de inicio del tratamiento con infusión intraduodenal de levodopa-carbidopa según los datos recogidos del Diario Oficial de Galicia, n.º 96, de 21 de mayo de 2014. |
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Ingreso hospitalario |
Régimen ambulatorio |
|
Hospitalización |
528,95 €/día |
0 € |
Estancia en hospital de día de neurología |
0 € |
196,01 €/día |
PEG |
1.707,12 € |
1.707,12 € |
Hospitalización a domicilio |
0 € |
80,70 €/día |
Consulta de seguimiento |
58,37 € |
58,37 € |
Total |
4.410,24 € |
2.676,32 € |
PEG: gastrostomía endoscópica percutánea. |
Outpatient establishment and initial management of treatment with intraduodenal levodopa-carbidopa infusion in advanced Parkinson’s disease Introduction. Treatment with intraduodenal levodopa-carbidopa infusion is one of the three therapies currently available for advanced Parkinson’s disease. It optimizes the benefit of antiparkinsonian treatment by counteracting the negative effect of erratic gastric emptying on the absorption of oral levodopa. The purpose is to describe our outpatient protocol of treatment establishment. Patients and methods. In our unit we have implemented a protocol for the treatment with intradoudenal levodopa-carbidopa infusion without admission based on the development of a multidisciplinary circuit among the Neurology Service, the Digestive Endoscopy Unit and the Home Hospitalization Unit. Results. Over one and a half year, we treated five patients with advanced Parkinson’s disease. All of them remain on the medication and no significant side effect has taken place. Conclusion. The outpatient onset install of this treatment saves costs and avoids the negative impact of admission on the patient with advanced Parkinson’s disease, in the same way that favors their adaptation and tolerability to it. Key words. Advanced Parkinson’s disease. Duodopa. Intraduodenal levodopa-carbidopa infusion. Motor fluctuations. Percutaneous endoscopic gastrostomy. |