Nondevice-assisted therapy for advanced Parkinson's disease with severe complications revisited for resource-restricted setup
Chandra Sadanandavalli Retnaswami1, Anupama R Pai2, P Chithra3, CS Vidhya Annapoorni4, Jogin Vargese5
1 Department of Neurology, Sri Ramakrishna Ashrama Charitable Hospital, Thiruvananthapuram, Kerala, India<, India
2 Department of Neuromicrobiology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
3 Department of Neurology, Government Medical College, Thiruvananthapuram, Kerala, India
4 Department of Paediatric Surgery, Government Medical College, Alappuzha, Kerala, India
5 Department of Neurology, Sri Ramakrishna Ashrama Charitable Hospital, Thiruvananthapuram, Kerala, India
Dr. Chandra Sadanandavalli Retnaswami
Department of Neurology, Sri Ramakrishna Ashrama Charitable Hospital, Sasthamangalam, Thiruvananthapuram
Source of Support: None, Conflict of Interest: None
INTRODUCTION: A good percentage of patients with parkinsonism land up with moderate-to-severe complications after 5 years of treatment which causes severe disability to patients and caregivers. Device-assisted treatments do not always give consistent results and availability and affordability is also a problem. Therefore, we, in our charitable hospital, tried in six consecutive patients the role of liquid Levodopa Carbidopa Ascorbic acid Solution therapy which is relatively cheap and does not need technical expertise.
MATERIALS AND METHODS: Patients who qualified as primary Parkinsonism and had severe complications as per the UPDR Section IV scoring and were considered unsuitable for device-assisted treatment options for various reasons were included for the study. They were given the LCAS therapy and scores repeated at 7 days and 4–6-month follow-up.
RESULTS: All patients had improved in UPDR IV scores, Everyday Abilities Scale for India, Zarit's score, and GDR. One patient had hyponatremia and all others remained stable at 4–6-month follow-up with 75% or less of their previous dose. All the parameters under dyskinesias and three of four parameters under fluctuations showed sustained improvement with significant P value at 1 week and 4–6 months in all cases.
LCAS is an easily accessible, cost effective treatment option which significantly improves quality of life in patients, who are not eligible or cannot afford Deep Brain Stimulation.