Objective: To review the benefits and complications of ILI for PD in a tertiary movement disorders center in Canada.

Background: ILI has been in use in Canada since 2011 to treat advanced PD, typically when oral medications are no longer tolerated due to increasing dyskinesias and/or ‘OFF times’. Long term outcomes in this patient population have not yet fully been elucidated. In Edmonton, ILI is executed by a multidisciplinary team including a neurologist, gastroenterologist, and a specialized nurse.

Methods: We performed a detailed chart review of all patients that have to-date been treated with ILI at our center. Information extracted included motor UPDRS scores, endoscopic reports, ILI pump and PEG-J tube complications. Additionally, patients and caregivers were interviewed at regular clinic follow up about their subjective experience with ILI, including overall satisfaction and complaints.

Results: 13 patients have received ILI [10M, 3F; mean age 65.6 yrs, range (51.8-79.5), PD duration 14.2yrs, range (9.1-22.0), mean follow-up 1.8yrs, range (0.2-4.8)]. Patients commonly reported improvement in motor function, decreased dyskinesias and ‘OFF times’ [mean motor UPDRS scores: pre-ILI 37.1, 1-6months post-ILI 27.5]; improvement persisted for the majority of patients. One patient noted return of sense of smell. Common complications included dislodgement, knotting or blockage of the jejunal tube extension requiring endoscopic re-insertion; 29 such incidents occurred across 6 patients in 5 years. Four patients discontinued Duodopa treatment, for reasons of declining cognition, inability to care for the pump, and/or minimal benefit. One patient died from unrelated causes.

Conclusions: The University of Alberta Hospital in Edmonton was the first center in Canada to enroll a patient in ILI therapy, under a research protocol; it is now available as a standard of practice. ILI is useful for the treatment of advanced PD, in patients that can care for the pump apparatus. The most common complication is jejunal tube displacement.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/intrajejunal-levodopa-infusion-ili-for-parkinsons-disease-pd-a-canadian-experience/