Name of the Procedure:

Common Name: Carbidopa/Levodopa Enteral Suspension
Medical Term: Carbidopa 5 mg/Levodopa 20 mg Enteral Suspension (J7340)

Summary

Carbidopa/Levodopa Enteral Suspension is a medication administered directly into the intestines to manage symptoms of Parkinson's disease. This method ensures a steady delivery of medication, helping to control symptoms more effectively than oral options.

Purpose

Medical Conditions:

• Parkinson's Disease

Goals:

• To provide consistent dopamine levels in the brain, reducing motor fluctuations.
• To improve control over symptoms such as tremors, rigidity, and bradykinesia (slowness of movement).

Indications

Symptoms:

• Severe motor fluctuations not controlled by oral medications.

• "Off" periods when medication is not working well.

  Patient Criteria:

• Diagnosed with Parkinson’s disease.
• Inadequate response to oral carbidopa/levodopa.

Preparation

• Patients may need to undergo fasting 8 hours before the procedure.
• Medication adjustments as advised by a healthcare provider.
• Pre-procedure diagnostic tests include a thorough medical evaluation and possible imaging studies.

Procedure Description

1. Insertion of Tube:

   • A small tube is surgically inserted through the abdomen into the small intestine.
   • This is usually done under local anesthesia with sedation or general anesthesia.

2. Medication Delivery:

   • The medication suspension is connected to the tube.
   • It is delivered continuously via an external pump.

Duration

The insertion procedure generally takes about 1-2 hours. Medication delivery is continuous as programmed by the healthcare provider.

Setting

• Typically performed in a hospital or surgical center.

Personnel

• Surgeons or gastroenterologists for tube placement.
• Nurses for pre and post-operative care.
• Anesthesiologists if general anesthesia is used.

Risks and Complications

Common Risks:

• Infection at the surgical site.
• Tube dislocation or blockage.

Rare Risks:

• Bowel perforation.
• Serious skin reactions.

Management:

• Infections are treated with antibiotics.
• Surgical intervention may be needed for severe complications.

Benefits

• Improved control of Parkinson’s symptoms.
• Reduced "off" periods allowing for greater daily functioning.
• Benefits often realized within days to a few weeks post-procedure.

Recovery

• Post-procedure, patients will be monitored for complications.
• Instructions include tube care and managing the external pump.
• Most patients can resume normal activities within a few days to a week, with some physical restrictions.
• Follow-up appointments to assess function and address any complications.

Alternatives

Other Treatment Options:

• Oral carbidopa/levodopa.
• Other Parkinson's medications.
• Deep brain stimulation.

Pros and Cons:

• Oral Medications: Easier to administer but less consistent symptom control.
• Deep Brain Stimulation: Effective for some but involves more invasive surgery.

Patient Experience

• During the procedure, patients are generally sedated or under anesthesia, experiencing minimal discomfort.
• Post-procedure, mild discomfort at the tube insertion site.
• Pain management with prescribed medications.
• Adjustment period for managing the pump device but generally improves with time.