Objective: We aimed to characterize Parkinson’s disease (PD) patients who developed the onset of new troublesome dyskinesias after Levodopa-Carbidopa Intestinal Gel (LCIG) initiation. We were particularly interested in patients who did not improve with conventional management strategies and presented atypical phenomenology, i.e. prolonged biphasic dyskinesias at pump discontinuation (atypical biphasic dyskinesias), isolated biphasic-like dyskinesias during infusion, and mixed-phenotypes (superimposition of peak-dose on biphasic-like dyskinesias).

Background: The efficacy of LCIG on motor fluctuations of PD patients has been recognized in a randomized trial, while the effect on troublesome dyskinesias has been indirectly supported by post-hoc analysis and is currently debated.

Method: We performed a retrospective survey analysis of a large cohort of LCIG patients and a retrospective longitudinal case-control study on a sample of PD patients followed at three time points (before LCIG, end of titration, latest follow-up). Patients who developed troublesome dyskinesias after LCIG, resistant to the routine titration were selected and compared to patients on LCIG with conventional motor complications.

Results: Thirty patients out of 208 (14.4%) reported biphasic-like continuous dyskinesias while on LCIG with/or without prolonged biphasic dyskinesias after pump disconnection at night. A subgroup of 8 patients (5.7%) presented peak-dose and biphasic-like dyskinesias (classified as ‘mixed phenotypes’). Groups were similar in terms of most demographic and clinical features but differed in type and severity of dyskinesias at baseline and follow-up. Daily course and clinical management of dyskinesias were also different. In particular, patients with biphasic-like dyskinesias get better with an increase in dopaminergic load in half the number of cases, while patients with mixed phenotype had the worst outcome and  highest drop-out rate (roughly 60% of these cases).

Conclusion: Our results show that biphasic-like dyskinesias could complicate the course of PD patients on LCIG. A higher frequency of patients with biphasic-like and mixed dyskinesias had a previous history of biphasic dyskinesias while on oral therapy. This study further informs the selection process of advanced therapy, particularly in the case of LCIG use to treat dyskinesias.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/biphasic-dyskinesias-in-parkinsons-disease-patients-treated-with-levodopa-carbidopa-intestinal-gel-insights-from-a-multicenter-retrospective-analysis/