Enteral Levodopa Therapy in Advanced Parkinson's Disease with Gastroparesis
Bibliographic record
Abstract
Levodopa is almost completely (~98%) absorbed in the distal part of the duodenum and the proximal jejunum. 1 In advanced Parkinson's disease (PD), transit of L-dopa from the stomach to the duodenum is erratic with delayed gastric emptying time, leading to fluctuations.2 By administering L-dopa directly into the proximal small intestine, the influence of gastric emptying rate can be negated.A 37-year-old right-handed woman developed a right-hand rest tremor in 2010.One year later, she noticed similar symptoms in her right foot with slowness of gait, micrographia, hypophonia, and masked facies.She was aware of anosmia for 1 year and constipation for 6 years before onset of tremor.There was no history of head injury, exposure to toxins, or psychiatric medications.Family history was negative.When first observed in the movement disorders clinic in 2011, Mini-Mental State Examination was 30/30.Cranial nerve examination was normal outside of masked facies.She demonstrated rigidity, bradykinesia, and resting tremor on the right side.Gait was bradykinetic with impaired postural reflexes.MRI brain was normal.Workup for Wilson's disease and secondary parkinsonian disorders were negative.She satisfied diagnostic criteria for PD and was started on pramipexole with good response, but it was discontinued because of significant nausea and vomiting.She was then started on L-dopa/carbidop- a, but could not tolerate it because of nausea.The L-dopa/ benzaseride tablet combination resulted in a good response with minimal nausea.Owing to increasing wearing off with freezing episodes and akinesia, L-dopa/benzaseride 100/25 mg was increased to 1 capsule every 2 hours by 2014.However, each dose provided only 1 hour of benefit and she remained off for more than 50% of the day with significant off dystonia.She was tried on other dopamine agonists (ropinorole, rotigotine), but, again, could not tolerate them because of severe nausea.Domperidone was not effective in controlling the nausea.Gradually, she began complaining of worsening gastrointestinal symptoms with persistent nausea and vomiting.She was
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".