ABSTRACT
BACKGROUND: Parkinson's disease (PD) is the second most common progressive neurodegenerative disease. In the advanced stages, the continuous delivery of levodopa (LD) as levodopa-carbidopa intestinal gel (LCIG) has demonstrated significant improvement of motor and nonmotor complications and improvement of the patients' quality of life (QoL). Despite the growing global experience with this treatment, anumber of unsolved practical issues remain, and currently, the data on the reasons that can lead to the discontinuation of LCIG are scarce. OBJECTIVE: In the present study, we aimed to analyze the causes that led to the discontinuation of LCIG therapy. METHODS: In this retrospective study, after 10 years of experience with LCIG as a therapeutic option in advanced PD, we analyzed the data of all dropout cases among the 204 patients that initiated LCIG therapy in two Romanian centers. RESULTS: Of the 204 patients enrolled, 43 patients dropped out. Disease duration until LCIG infusion was significantly longer (11.67±4.98 vs 9.44±3.44) and the overall clinical picture more sever (both regarding motor symptoms and cognitive decline) in dropout patients (compared to patients who continued treatment). The dropout patients also presented significant differences regarding the incidence of polyneuropathy (32.5% vs 11.18%). The main cause of discontinuation was death. CONCLUSION: The causes of discontinuation from LCIG therapy in Romanian patients are similar to those from other centers; however, the rate of dropouts is somewhat lower. The clinician's experience in selecting and treating the patients in advanced stages of PD can increase therapeutic adherence. Also, the presence of a well-trained caregiver along with the availability of a proper aftercare system is mandatory for maintaining the long-term benefits of the therapy and the overall best outcome possible. Targeted prospective studies are needed to confirm whether a more severe stage of the disease and cognitive impairment at the time of initiation, respectively, the association of polyneuropathy can be considered as predictive factors for dropout.
ABSTRACT
In-beam dose measurements are paramount for any application seeking to harness the effects of the radiation beam, so all the future applications of the laser accelerated beams (as generated in the ELI and CETAL projects) will need such measurements. With a very long history in measuring doses in charged particle beams, the medical and industrial applications setup a number of methods that could be also used for the dosimetry of the beams generated by laser pulses. Dose measurements rely heavily on what is seen as the gold standard in dose measurement: the ion chambers. Ion chambers have both limitations and advantages, and in our case the disadvantage could be the large number of corrections to be applied in order to calculate a correct dose from the measured charge. The ELIDOSE project tries to address these problems by proposing an array detector that would allow the simultaneous measurement of the recombination and polarity corrections, and of the dose. The detector consists of four identical ion chambers mounted together in a PMMA frame and the project will analyze its response to various charged particle beams and the reciprocal influences of the chambers on each other. These reciprocal influences of the four chambers are studied through the FLUKA modeling of the detector and, in order to hone the simulations of the detectors, we initially compared the results of the measurements performed with an Advanced MarkusTM chamber in the proton beam delivered at the 3-MV TandetronTM from IFIN-HH. The paper presents the results of these initial measurements and how these results will be used to modify the simulation parameters.
