By GREGORY ZELLER //
They’re dancing in the aisles, literally, at North Shore University Hospital, thanks to a revolutionary treatment for Parkinson’s disease.
Surgeons at the Manhasset hospital, part of the Northwell Health system, recently completed their first endoscopic procedure involving Duopa, an effective drug combo administered via a cutting-edge cassette-pump system marketed by Chicago-based pharma AbbVie Inc.
Approved by the FDA in January, Duopa marks the first Parkinson’s disease treatment to administer medicine – in this case, a gel-suspended combination of carbidopa and levodopa – for 16 consecutive hours.
A common and successful anti-Parkinson’s cocktail, carbidopa and levodopa come in other forms – primarily pills – but problems with dosage levels, patient responsibility and blood-absorption rates frequently lead to “off times,” when the medications wane and the degenerative central nervous system disorder strikes hard.
“The pills work,” NSUH neurology chairman Paul Wright told Innovate LI. “But advanced Parkinson’s disease can require patients to take pills very often, sometimes every two hours. And the absorption into the blood stream and the brain isn’t always consistent.
“If you’re planning your day around being able to walk, you might not be able to function if you need the medication to be at peak effect,” Wright added.
Enter the Duopa pump, which requires a minimally invasive endoscopic procedure – performed at NSUH by gastroenterologists Jaydeep Kadam and Kostas Sideridis – to insert a tube in the small intestine, connected to the external pump.
The pump attaches to a cassette containing the two dopamine-based medications, which are always administered to Parkinson’s disease patients in tandem, Wright noted: the levodopa to counter the disease’s symptoms, the carbidopa to mitigate levodopa’s side effects.
The cassette/pump system blends automated dosing and patient control. Upon waking in the morning, the patient administers a large dose by attaching a fresh cassette to the pump; the system then slowly administers the cocktail throughout the day, allowing consistent symptom control.
Patients can also administer a “rescue dose,” Wright noted, in case of emergency.
“Depending on what we’ve discussed or how we program the pump, he can administer an extra dose of he has difficulty walking or is feeling increased rigidity or tightness,” the neurologist noted.
The system is “absolutely not” difficult to operate, according to Wright, no small consideration for a patient population known to suffer severe motor-skill deficiencies. There’s no risk of overdose, and patients are still eligible to take other prescription Parkinson’s disease treatments, as necessary, when Duopa’s 16-hour program shuts down for the night.
The first NSUH patient to undergo the procedure was John McKeon, a former commissioner of the Rockville Centre Police Department, who was diagnosed with Parkinson’s disease in 2009.
McKeon – who retired in 2010 after 37 years with the Rockville Centre PD and is also retired from the U.S. Naval Reserve and the U.S. Naval Criminal Investigative Service – had been treated over the years with a dozen different medications to help control his Parkinson’s disease symptoms, according to Wright, who is McKeon’s personal neurologist.
While the medications were sometimes effective, the degenerative disease was winning the fight. The “off times” left McKeon frequently unable to walk – and made him “an ideal candidate to receive this innovative treatment,” Wright noted.
McKeon underwent the endscopic procedure May 26. According to NSUH, a half-hour after receiving his first kick-start dose through the Duopa pump, the ex-cop was up and dancing with his wife, something he hadn’t been able to do in years.
And the patient’s prognosis has only improved over the since the procedure, according to Wright, who said McKeon – who has followed Duopa protocols regarding follow-up visits and symptom tracking, meant to maximize his personal dosage effectiveness – has been able to shop with his wife and help with the dishes, and even attended the Bethpage Air Show at Jones Beach over Memorial Day weekend.
“In the past, he had the desire to go but knew he wasn’t stable enough,” Wright noted. “He didn’t know if the medication would hold, if he’d be able to walk or stand for extended periods of time.”
It’s a very positive sign for the former police commissioner – and for all advanced Parkinson’s disease patients, according to NSUH’s neurology chair.
“I expect this will work our really well for [McKeon],” Wright said. “And for a select group of patients, I predict this will be very effective.”