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NEUROLOGY 1988;38:419
© 1988 American Academy of Neurology

Erratic gastric emptying of levodopa may cause "random" fluctuations of parkinsonian mobility

R. Kurlan, MD, K. P. Rothfield, AB, W. R. Woodward, PhD, J. G. Nutt, MD, C. Miller, RN, MS, D. Lichter, MD and I. Shoulson, MD

From the Department of Neurology (Dr. Kurlan, Mr. Rothfield, Ms. Miller, and Drs. Lichter and Shoulson), University of Rochester School of Medicine, Rochester, NY; and the Department of Neurology (Drs. Woodward and Nutt), Oregon University Health Sciences Center, Portland, OR.

The pathogenesis of "random" fluctuations in parkinsonian mobility, which are not clearly related to the dosing schedule of levodopa, has not been determined. We rated parkinsonian mobility and assayed plasma dopa in one patient with clinically random fluctuations during two modes of administration of levodopa/carbidopa: (1) standard oral route and (2) direct duodenal delivery via nasoduodenal tube. During oral therapy, mobility varied unpredictably in relation to levodopa dosing, suggesting a clinically random pattern. During duodenal delivery, however, a predictable and dramatic pattern of recurrent end-of-dose deterioration was observed; each intraduodenal levodopa dose resulted in 60 to 90 minutes of benefit. Plasma dopa levels correlated closely with mobility ratings for both modes of administration. Our findings indicate that erratic gastric emptying of levodopa is responsible for apparently "random" oscillations in mobility in at least one patient with Parkinson's disease and probably in others.

Address correspondence and reprint requests to Dr. Kurlan, Department of Neurology, University of Rochester School of Medicine, 601 Elmwood Avenue, Rochester, NY 14642.

Received May 22, 1987. Accepted for publication in final form July 16, 1987.




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