{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,26]],"date-time":"2026-02-26T15:02:58Z","timestamp":1772118178768,"version":"3.50.1"},"reference-count":21,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2024,12,11]],"date-time":"2024-12-11T00:00:00Z","timestamp":1733875200000},"content-version":"vor","delay-in-days":10,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100007797","name":"Helsingin Yliopisto","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100007797","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Brain and Behavior"],"published-print":{"date-parts":[[2024,12]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Levodopa\u2013carbidopa intestinal gel (LCIG) is an established treatment option in advanced Parkinson's disease (PD). LCIG treatment is usually initiated with a nasojejunal tube (NJT) test phase before percutaneous endoscopic transgastric jejunostomy (PEG\u2010J) tube installation. However, some centers have used direct initiation with PEG\u2010J. Data comparing these approaches are scarce. The objective of this study was to analyze the risks and benefits of direct PEG\u2010J initiation after a positive levodopa challenge test (LCT) for selected patients compared to initiation with a temporary NJT test phase.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Thirty\u2010three consecutive advanced PD patients commenced LCIG\u2010treatment between February 2016 and December 2019 at Helsinki University Hospital. Of them, 11 (33%) selected patients had direct initiation without an NJT test phase. Treatment discontinuations and adverse events during the first 6\u00a0months of treatment were evaluated retrospectively. The duration of hospital stay related to the initiation of the treatment was compared between the groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Between the direct initiation and NJT test phase groups, there were no significant differences in treatment discontinuations (0 vs. 1, respectively); the number of inner tube or PEG\u2010J tube replacements (1 vs. 3); or infection complications (1 vs. 3) during the first 6\u00a0months of treatment. Direct initiation significantly reduced the hospital stay related to treatment initiation (mean 7 vs. 9\u00a0days,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>For selected patients, the direct initiation of LCIG after a positive LCT, without a temporary NJT test phase, appears safe and does not lead to additional treatment discontinuations or complications.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/brb3.70193","type":"journal-article","created":{"date-parts":[[2024,12,12]],"date-time":"2024-12-12T02:12:04Z","timestamp":1733969524000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Direct Initiation of Levodopa\u2013Carbidopa Intestinal Gel Infusion After a Positive Levodopa Challenge Test in Advanced Parkinson's Disease"],"prefix":"10.1002","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2679-4705","authenticated-orcid":false,"given":"Vili","family":"Viljaharju","sequence":"first","affiliation":[{"name":"Department of Neurology Helsinki University Hospital  Helsinki Finland"},{"name":"Department of Clinical Neurosciences (Neurology) University of Helsinki  Helsinki Finland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tuomas","family":"Mertsalmi","sequence":"additional","affiliation":[{"name":"Department of Neurology Helsinki University Hospital  Helsinki Finland"},{"name":"Department of Clinical Neurosciences (Neurology) University of Helsinki  Helsinki Finland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"K. Amande M.","family":"Pauls","sequence":"additional","affiliation":[{"name":"Department of Neurology Helsinki University Hospital  Helsinki Finland"},{"name":"Department of Clinical Neurosciences (Neurology) University of Helsinki  Helsinki Finland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7921-5412","authenticated-orcid":false,"given":"Maija","family":"Koivu","sequence":"additional","affiliation":[{"name":"Department of Neurology Helsinki University Hospital  Helsinki Finland"},{"name":"Department of Clinical Neurosciences (Neurology) University of Helsinki  Helsinki Finland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Johanna","family":"Eerola\u2010Rautio","sequence":"additional","affiliation":[{"name":"Department of Neurology Helsinki University Hospital  Helsinki Finland"},{"name":"Department of Clinical Neurosciences (Neurology) University of Helsinki  Helsinki Finland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8916-640X","authenticated-orcid":false,"given":"Marianne","family":"Udd","sequence":"additional","affiliation":[{"name":"Department of Gastroenterological Surgery Helsinki University Hospital  Helsinki Finland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eero","family":"Pekkonen","sequence":"additional","affiliation":[{"name":"Department of Neurology Helsinki University Hospital  Helsinki Finland"},{"name":"Department of Clinical Neurosciences (Neurology) University of Helsinki  Helsinki Finland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2024,12,11]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.parkreldis.2017.09.018"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.3748\/wjg.v20.i26.8505"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1001\/archneurol.2010.260"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.parkreldis.2015.05.014"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00415\u2010018\u20108951\u20103"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/mds.22450"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/mds.26123"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/0022\u20103956(75)90026\u20106"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/mds.22021"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1002\/mds.22596"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1002\/mds.20962"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.3233\/JPD\u2010201978"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1468\u20101331.2012.03679.x"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1474\u20104422(13)70293\u2010X"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0b013e3181a1d44c"},{"issue":"6","key":"e_1_2_10_17_1","first-page":"861","article-title":"Intestinal Levodopa Infusion: The Belgian Experience","volume":"35","author":"Pickut B. 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