{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T03:00:04Z","timestamp":1790650804217,"version":"4.1.0"},"reference-count":29,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2025,2,4]],"date-time":"2025-02-04T00:00:00Z","timestamp":1738627200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["movementdisorders.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Movement Disord Clin Pract"],"published-print":{"date-parts":[[2025,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Real\u2010world clinical evidence is missing to understand the resorption characteristics of levodopa through duodenal and jejunal parts of the small intestine.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p>To characterize how different application sites of intestinal levodopa gel would impact on levodopa dosing and clinical outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This multicentre retrospective analysis investigated Parkinson's disease patients (n\u2009=\u2009111) and their change in levodopa equivalent dosage when switching from oral treatment to intestinal continuous infusion therapy while stratifying for differences in percutaneous gastrojejunostomy (PEG\u2010J) tube localizations. We analyzed data from patients treated with both levodopa\u2013carbidopa (LCIG) and levodopa\u2013carbidopa\u2013entacapone (LECIG) intestinal gel.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In dichotomic analysis, duodenal and jejunal tube positions showed similar levodopa equivalent dosages changes from baseline (<jats:italic>P<\/jats:italic>\u2009=\u20090.143). This was similar when subdividing patients for LCIG and LECIG treatment. In duodenal PEG\u2010J positions, 44.4% of patients showed persistent motor fluctuations compared to 21.9% in jejunal placements (<jats:italic>P<\/jats:italic>\u2009=\u20090.026). In duodenal positions, fluctuations most often persisted when the PEG\u2010J tube was placed proximally into the duodenum. In jejunal localizations, several patients displayed a satisfactory outcome from the primary intervention but experienced dislocation of the PEG\u2010J tube to a duodenal position. This was associated with re\u2010emergence of motor fluctuations in a majority of them.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Our real\u2010world data suggest that LCIG and LECIG are absorbed similarly in both duodenal and jejunal portions of the small intestine. However, clinical data suggest, that jejunal positioning is critical to the stabilization of dopaminergic motor fluctuations.<\/jats:p><\/jats:sec>","DOI":"10.1002\/mdc3.14352","type":"journal-article","created":{"date-parts":[[2025,2,4]],"date-time":"2025-02-04T04:58:26Z","timestamp":1738645106000},"page":"614-625","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Localization Matters: Impacts of <scp>PEG\u2010J<\/scp> Localization in Intestinal Levodopa Therapy for Parkinson's Disease"],"prefix":"10.1002","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0868-5270","authenticated-orcid":false,"given":"Philipp","family":"Klocke","sequence":"first","affiliation":[{"name":"Centre for Neurology, Department for Neurodegenerative Diseases, and Hertie\u2010Institute for Clinical Brain Research University of T\u00fcbingen  T\u00fcbingen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Moritz A.","family":"Loeffler","sequence":"additional","affiliation":[{"name":"Centre for Neurology, Department for Neurodegenerative Diseases, and Hertie\u2010Institute for Clinical Brain Research University of T\u00fcbingen  T\u00fcbingen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1458-9173","authenticated-orcid":false,"given":"Idil","family":"Cebi","sequence":"additional","affiliation":[{"name":"Centre for Neurology, Department for Neurodegenerative Diseases, and Hertie\u2010Institute for Clinical Brain Research University of T\u00fcbingen  T\u00fcbingen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karl\u2010Ernst","family":"Grund","sequence":"additional","affiliation":[{"name":"Centre for General Surgery, Department for Surgical Endoscopy University Medical Centre T\u00fcbingen  T\u00fcbingen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christine","family":"Daniels","sequence":"additional","affiliation":[{"name":"Department of Neurology University Hospital and Julius\u2010Maximilians\u2010University  W\u00fcrzburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jens","family":"Volkmann","sequence":"additional","affiliation":[{"name":"Department of Neurology University Hospital and Julius\u2010Maximilians\u2010University  W\u00fcrzburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiri","family":"Koschel","sequence":"additional","affiliation":[{"name":"Parkinson\u2010Klinik Ortenau  Wolfach Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8574-3297","authenticated-orcid":false,"given":"Wolfgang H.","family":"Jost","sequence":"additional","affiliation":[{"name":"Parkinson\u2010Klinik Ortenau  Wolfach Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kazimierz","family":"Logmin","sequence":"additional","affiliation":[{"name":"Department of Neurology and Neurorehabilitation Hospital Zum Heiligen Geist, Academic Teaching Hospital of the Heinrich\u2010Heine\u2010University D\u00fcsseldorf  Kempen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lars","family":"Wojtecki","sequence":"additional","affiliation":[{"name":"Department of Neurology and Neurorehabilitation Hospital Zum Heiligen Geist, Academic Teaching Hospital of the Heinrich\u2010Heine\u2010University D\u00fcsseldorf  Kempen Germany"},{"name":"Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich\u2010Heine\u2010University D\u00fcsseldorf  D\u00fcsseldorf Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christoph R.","family":"Werner","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Gastrointestinal Oncology, Hepatology, Infectiology, and Geriatrics University Hospital of T\u00fcbingen  T\u00fcbingen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0447-7132","authenticated-orcid":false,"given":"Daniel","family":"Weiss","sequence":"additional","affiliation":[{"name":"Centre for Neurology, Department for Neurodegenerative Diseases, and Hertie\u2010Institute for Clinical Brain Research University of T\u00fcbingen  T\u00fcbingen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,2,4]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1212\/01.Wnl.0000149637.70961.4c"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1208\/s12248-012-9439-1"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/bcp.12324"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1468-1331.2011.03614.x"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/mds.26855"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.3390\/jpm11040254"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1517\/14740338.2014.896336"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00702-023-02601-0"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41531-022-00295-x"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1517\/17425255.4.2.193"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1007\/bf00544017"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.phrs.2007.06.005"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2125.1993.tb05691.x"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1038\/npjsba.2016.13"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1097\/00002826-200603000-00001"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1002\/mds.22176"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/0024-3205(91)90104-j"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/0024-3205(88)90330-x"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.1002\/mds.29410"},{"key":"e_1_2_9_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.gie.2008.06.038"},{"key":"e_1_2_9_22_1","doi-asserted-by":"publisher","DOI":"10.1124\/jpet.114.216317"},{"key":"e_1_2_9_23_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00702-015-1496-z"},{"key":"e_1_2_9_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.parkreldis.2017.09.018"},{"key":"e_1_2_9_25_1","doi-asserted-by":"publisher","DOI":"10.1002\/mdc3.13926"},{"key":"e_1_2_9_26_1","doi-asserted-by":"publisher","DOI":"10.1002\/mds.22450"},{"key":"e_1_2_9_27_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(13)70293-X"},{"key":"e_1_2_9_28_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00702-013-1026-9"},{"key":"e_1_2_9_29_1","doi-asserted-by":"publisher","DOI":"10.1111\/ene.15734"},{"key":"e_1_2_9_30_1","doi-asserted-by":"publisher","DOI":"10.3389\/fneur.2023.1174698"}],"container-title":["Movement Disorders Clinical Practice"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/movementdisorders.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/mdc3.14352","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,20]],"date-time":"2025-10-20T11:01:31Z","timestamp":1760958091000},"score":1,"resource":{"primary":{"URL":"https:\/\/movementdisorders.onlinelibrary.wiley.com\/doi\/10.1002\/mdc3.14352"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,2,4]]},"references-count":29,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2025,5]]}},"alternative-id":["10.1002\/mdc3.14352"],"URL":"https:\/\/doi.org\/10.1002\/mdc3.14352","archive":["Portico"],"relation":{},"ISSN":["2330-1619","2330-1619"],"issn-type":[{"value":"2330-1619","type":"print"},{"value":"2330-1619","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,2,4]]},"assertion":[{"value":"2024-09-05","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-01-21","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-02-04","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}