Improving Sleep Quality in Parkinson's: Is Levodopa-Carbidopa Intestinal Gel Effective?
LCIG infusion is a therapeutic option for advanced PD patients complicated with motor fluctuations refractory to conventional treatment.
Participants with advanced Parkinson disease (PD) who were treated with levodopa-carbidopa intestinal gel infusion did not experience reduced quality of sleep and results showed trends toward sleep quality improvement, according to a review published in Parkinson's Disease.
The investigators of this single-center, open-label prospective pilot study (ClinicalTrials.gov identifier: NCT03602924) sought to evaluate the effect of levodopa-carbidopa intestinal gel infusion on sleep quality in patients with advanced PD using quantitative and qualitative measures.
The study sample included 7 consecutive participants who received an implant for continuous levodopa-carbidopa intestinal gel infusion; dosage was titrated individually until greatest motor control was attained. The investigators performed overnight polysomnography before and after 6 months of treatment, reporting on parameters including sleep efficiency, wake after sleep onset, REM sleep and non-REM sleep, snoring sounds, apnea-hypopnea index, arousals, leg movements in sleep, and more. The investigators also administered questionnaires at baseline and follow-up, including the Epworth Sleepiness Scale, fatigue scale, Pittsburgh Sleep Quality Index, Beck Depression Inventory, and the Hamilton Anxiety Rating Scale.
Motor fluctuations and symptoms showed significant improvement after 6 months of continuous levodopa-carbidopa intestinal gel infusion. Polysomnography results showed improvements in generalized sleep efficiency; however, changes observed in sleep parameters from baseline to follow-up were not considered statistically significant.
After 6 months of levodopa-carbidopa intestinal gel infusion, the percentage of REM sleep decreased from 16.2%±9.9% to 10.4%±6.8% (P =.08) and sleep arousals decreased from 15.0±7.0 to 12.9±5.6 (P =.115); these reductions were attributed primarily to a reduction of spontaneous arousals (7.5±3.1 to 5.2±5.0; P =.075) and periodic leg movements during REM sleep (20.7±31.6 to 2.9±3.7; P =.285). At follow-up, the mean percentage of non-REM sleep increased from 83.6%±10.2% to 89.6%±6.8% but did not reach statistical significance.
Compared with baseline scores, the questionnaires also reported an improvement in sleep quality, fatigue, and daytime sleepiness after 6 months of levodopa-carbidopa intestinal gel infusion.
A limitation of the study was the small sample population of 7 patients which was insufficient to attribute clinical significance to any of the results.
The results indicated that treatment with levodopa-carbidopa intestinal gel infusion did not aggravate the quality of sleep in patients with advanced PD as shown by a reduction in spontaneous arousals and periodic leg movements during REM sleep. The researchers conclude that future research with larger study populations is necessary "to clarify the positive influence of [levodopa-carbidopa intestinal gel] on sleep quality in patients with advanced PD."
De Fabregues O, Ferré A, Romero O, Quintana M, Alvarez-Sabin J. Sleep quality and levodopa intestinal gel infusion in Parkinson's disease: a pilot study [published online November 1, 2018]. Parkinsons Dis. doi:10.1155/2018/8691495