Objective: To investigate the long-term effect of levodopa-carbidopa intestinal gel (LCIG) on gait and posture by means of both clinical and objective measures in Parkinson’s disease (PD) patients.

Background: Abnormal in posture and gait are the common problem which occurs in advanced PD patients. The constant dopaminergic drug delivery attained by LCIG infusion reduce motor fluctuations and give a good result in long-term management of motor complications. Few data have suggested that LCIG treatment may have a beneficial effect on PD axial signs. However, data are scarce and principally restricted to a short-term follow-up.

Method: We evaluated changes in posture and gait parameters from T0, before the LCIG start during MED ON, and T1, during LCIG treatment in 10 patients. As the primary outcome, we compared the UPDRS item 28 and 29 scores between T0 and T1. Data of motor symptoms and motor complications were assessed by means of the UPDRS part III and IV, respectively. We used Kinovea to analyze posture and gait analyzing on T0 and T1 videos of the patients. Neck flexion (NF), Total camptocormia (TC),Upper camptocormia (UC), and Lateral flexion (LF) were measured as the posture parameters. Right step length (RS), Left step length (LS), and velocity were measured as the gait parameters.

Results: After a mean of 41.10±22.68 months of LCIG infusion, the UPDRS item 28 (posture) changed from 1.20±0.79 to 1.30±0.68 (p = 0.591) the UPDRS item 29 (gait) varied from 1.15±1.00 to 2.00±0.82 (p=0.052).The UPDRS-III total score got significantly worsen (p=0.004). The gait and posture parameters showed no statistically significant changes at follow-up. Indeed, RS changed from 40.81±10.99 at T0 to 39.50±11.70 cm at T1 (p = 0.765). LS changed from 40.27±11.71 at T0 to 39.23±9.34 cm at T1 (p = 0.784).The velocity changed from 0.97±0.41 at T0 to 0.82±0.25 m/s at T1 (p = 0.256).The posture parameters showed NF changed from 20.44±8.56 at T0 to 23.10±7.14 degrees at T1 (p = 0.232).TC changed from 22.11±7.08 at T0 to 26.44±8.41 degrees at T1 (p = 0.148).UC changed from33.78±9.97 at T0 to 37.44±7.43 degrees at T1 (p = 0.354).LF changed from 0.90±0.99 at T0 to 2.60±3.89 degrees at T1 (p = 0.155).

Conclusion: Our data seem to indicate that after about three and half years of LCIG treatment, PD patients do not show a significant improvement of gait and posture parameters thought substantial stability.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/levodopa-carbidopa-intestinal-gel-infusion-a-video-analysis-of-long-term-effect-on-gait-and-posture/