開腹胃瘻造設術により，レボドパ/カルビドパ配合経腸用液療法を導入したパーキンソン病の1例
症例は68歳，男性．20歳時に十二指腸潰瘍により幽門側胃切除術，Billroth II法再建後であった．57歳時にパーキンソン病と診断され薬物治療が開始された．薬剤調整を行ったが日常生活に支障をきたすウェアリングオフとジスキネジアを認めるようになった．レボドパ/カルビドパ配合経腸用液（levodopa-carbidopa intestinal gel; LCIG）療法導入を検討したが，腹壁癒着により経皮内視鏡的胃瘻造設術は施術困難であった．そのため，開腹胃瘻造設術によりLCIG療法導入し，経過は良好であった．本例は開腹胃瘻造設術によりLCIG療法を導入した本邦初の報告である．...
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| Published in | 臨床神経学 Vol. 58; no. 9; pp. 570 - 573 |
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| Main Authors | , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
日本神経学会
2018
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| Subjects | |
| Online Access | Get full text |
| ISSN | 0009-918X 1882-0654 |
| DOI | 10.5692/clinicalneurol.cn-001150 |
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| Abstract | 症例は68歳，男性．20歳時に十二指腸潰瘍により幽門側胃切除術，Billroth II法再建後であった．57歳時にパーキンソン病と診断され薬物治療が開始された．薬剤調整を行ったが日常生活に支障をきたすウェアリングオフとジスキネジアを認めるようになった．レボドパ/カルビドパ配合経腸用液（levodopa-carbidopa intestinal gel; LCIG）療法導入を検討したが，腹壁癒着により経皮内視鏡的胃瘻造設術は施術困難であった．そのため，開腹胃瘻造設術によりLCIG療法導入し，経過は良好であった．本例は開腹胃瘻造設術によりLCIG療法を導入した本邦初の報告である． |
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| AbstractList | 症例は68歳，男性．20歳時に十二指腸潰瘍により幽門側胃切除術，Billroth II法再建後であった．57歳時にパーキンソン病と診断され薬物治療が開始された．薬剤調整を行ったが日常生活に支障をきたすウェアリングオフとジスキネジアを認めるようになった．レボドパ/カルビドパ配合経腸用液（levodopa-carbidopa intestinal gel; LCIG）療法導入を検討したが，腹壁癒着により経皮内視鏡的胃瘻造設術は施術困難であった．そのため，開腹胃瘻造設術によりLCIG療法導入し，経過は良好であった．本例は開腹胃瘻造設術によりLCIG療法を導入した本邦初の報告である． |
| Author | 廣澤, 太輔 島村, 宗尚 佐々木, 勉 池中, 建介 中野, 智仁 望月, 秀樹 |
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| References | 3) Carmagnola S, Balzarini M, Anderloni A, et al. Employment of transgastric-jejunal infusion tube for intraduodenal administration of levodopa. Dig Liver Dis 2011;43:S227. 7) Uncini A, Eleopra R, Onofrj M. Polyneuropathy associated with duodenal infusion of levodopa in Parkinson’s disease: features, pathogenesis and management. J Neurol Neurosurg Psychiatry 2015;86:490-495. 8) Murata M, Mihara M, Hasegawa K, et al. Efficacy and safety of levodopa-carbidopa intestinal gel from a study in Japanese, Taiwanese, and Korean advanced Parkinson’s disease patients. NPJ Parkinsons Dis 2016;2:16020. 4) Markos P, Bilic B, Miletic V. Jejunal cathetel placement for levodopa-carbidopa infusion in a patient with Billroth I gastrectomy. Endoscopy 2016;48:E288. 6) Lang AE, Rodriguez RL, Boyd JT, et al. Integrated safety of levodopa-carbidopa intestinal gel from prospective clinical trials. Mov Diord 2016;31:538-546. 2) Odin P, Ray Chaudhuri K, Slevin JT, et al. Collective physician perspectives on non-oral medication approaches for the management of clinically relevant unresolved issues in Parkinson’s disease: Consensus from an international survey and discussion program. Parkinsonism Relat Disord 2015;21:1133-1144. 11) Lim AH, Schoeman MN, Nguyen NQ. Long-term outcomes of direct percutaneous endoscopic jejunostomy: a 10-year cohort. Endosc Int Open 2015;3:E610-E614 9) De Fabregues O, Dot J, Abu-Suboh M, et al. Long-term safety and effectiveness of levodopa-carbidopa intestinal gel infusion. Brain Behav 2017;7:e00758. 1) Timpka J, Nitu B, Datieva V, et al. Device-aided treatment strategies in advanced Parkinson’s disease. Int Rev Neurobiol 2017;132:453-474. 10) Kimber TE, Schoeman M. Direct endoscopic jejunosotomy for the administration of levodopa-carbidopa intestinal gel in Parkinson’s disease. Parkinsonism Relat Disord 2014;20:786-788. 5) Ljungdahl M, Sundbom M. Complication rate lower after percutaneous endoscopic gastrostomy than after surgical gastrostomy: a prospective, randomized trial. Surg Endosc 2006;20:1248-1251. |
| References_xml | – reference: 3) Carmagnola S, Balzarini M, Anderloni A, et al. Employment of transgastric-jejunal infusion tube for intraduodenal administration of levodopa. Dig Liver Dis 2011;43:S227. – reference: 10) Kimber TE, Schoeman M. Direct endoscopic jejunosotomy for the administration of levodopa-carbidopa intestinal gel in Parkinson’s disease. Parkinsonism Relat Disord 2014;20:786-788. – reference: 11) Lim AH, Schoeman MN, Nguyen NQ. Long-term outcomes of direct percutaneous endoscopic jejunostomy: a 10-year cohort. Endosc Int Open 2015;3:E610-E614 – reference: 4) Markos P, Bilic B, Miletic V. Jejunal cathetel placement for levodopa-carbidopa infusion in a patient with Billroth I gastrectomy. Endoscopy 2016;48:E288. – reference: 2) Odin P, Ray Chaudhuri K, Slevin JT, et al. Collective physician perspectives on non-oral medication approaches for the management of clinically relevant unresolved issues in Parkinson’s disease: Consensus from an international survey and discussion program. Parkinsonism Relat Disord 2015;21:1133-1144. – reference: 6) Lang AE, Rodriguez RL, Boyd JT, et al. Integrated safety of levodopa-carbidopa intestinal gel from prospective clinical trials. Mov Diord 2016;31:538-546. – reference: 5) Ljungdahl M, Sundbom M. Complication rate lower after percutaneous endoscopic gastrostomy than after surgical gastrostomy: a prospective, randomized trial. Surg Endosc 2006;20:1248-1251. – reference: 9) De Fabregues O, Dot J, Abu-Suboh M, et al. Long-term safety and effectiveness of levodopa-carbidopa intestinal gel infusion. Brain Behav 2017;7:e00758. – reference: 7) Uncini A, Eleopra R, Onofrj M. Polyneuropathy associated with duodenal infusion of levodopa in Parkinson’s disease: features, pathogenesis and management. J Neurol Neurosurg Psychiatry 2015;86:490-495. – reference: 1) Timpka J, Nitu B, Datieva V, et al. Device-aided treatment strategies in advanced Parkinson’s disease. Int Rev Neurobiol 2017;132:453-474. – reference: 8) Murata M, Mihara M, Hasegawa K, et al. Efficacy and safety of levodopa-carbidopa intestinal gel from a study in Japanese, Taiwanese, and Korean advanced Parkinson’s disease patients. NPJ Parkinsons Dis 2016;2:16020. |
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| SubjectTerms | パーキンソン病 レボドパ/カルビドパ配合経腸用液療法 持続的ドパミン刺激療法 経皮内視鏡的胃瘻造設術 開腹胃瘻造設術 |
| Title | 開腹胃瘻造設術により，レボドパ/カルビドパ配合経腸用液療法を導入したパーキンソン病の1例 |
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