Objective: To describe the benefits of adding levodopa–carbidopa intestinal gel infusion (LCIG) therapy to Parkinson’s disease (PD) patients on deep brain stimulation (DBS).

Background: Device-aided therapies for PD include DBS LCIG infusion via percutaneous gastrojejunostomy (PEG) and apomorphine subcutaneous infusion. They all aim at treating complications of oral dopaminergic medications such as motor fluctuations and dyskinesia. A recent study assessed the effect of LCIG therapy as an adjunctive treatment to advanced PD patients receiving DBS. After initial benefit with DBS some patients experience significant motor fluctuations with oral levodopa therapy suggesting potential benefit of adding infusion therapies.

Methods: We present a case series of PD patients from two movement disorder centers in Israel. All of the patients were initially treated with STN DBS with significant benefit. After further progression of their disease with poor control of symptoms, LCIG treatment was added.

Results: 7 patients (5=male) are presented in our series. 2 patients had an early onset PD. Symptoms duration from first PD symptoms to DBS was 6-12 years. Duration from DBS implantation to LCIG treatment initiation was 3-10 years. The patients had either unilateral (2) or bilateral (5) STN DBS and one patient also had additional bilateral GPI electrodes. In one patient PEG was also used for feeding. All patients improved after initiation of LCIG therapy. Most had reduced OFF time and/or reduction in ON time associated with troublesome dyskinesia. Motor symptoms such as freezing of gait improved as well. Non-motor symptoms which improved included pain, sleep, somnolence. However, balance and cognition did not improve as well as functional deficits in patients dependent on 24-hours caregiver help.

Conclusions: In the described case series, PD patients with advanced disease treated with DBS, had additional benefit from initiation of LCIG treatment. One observation is that addition of LCIG therapy may be helpful for adjustment of levodopa in patients stimulated unilaterally. In an era of personalized medicine for PD patients, combining advanced treatments can have a significant impact on patient’s symptoms and disability.

References: Duodenal Levodopa Infusion for Long-Term Deep Brain Stimulation-Refractory Symptoms in Advanced Parkinson Disease. Regidor I, Benita V, Del Álamo de Pedro M, Ley L, Martinez Castrillo JC. Clinical Neuropharmacology. 2017 May/Jun;40(3):103-107.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/dual-device-aided-therapy-for-patients-with-advanced-parkinsons-disease-a-case-series/