Objective: To investigate the effectiveness of Levodopa carbidopa ascorbic acid solution (LCAS) in reducing the severity of bradykinesia and dyskinesia in advanced Parkinson’s disease (PD).

Background: In advanced PD the response to oral tablets becomes unpredictable. The resultant motor fluctuations can impact on the person’s quality of life and loss of independence. This unpredictability is due to decreased gastric motility, reduced absorption of levodopa (L-DOPA) and central striatal denervation changes. LCAS is effective as it bypasses the stomach and is reliably absorbed in the jejeunum1. The hourly administration allows consistency in circulating L-dopa and the capacity of micro-titration enables the maximisation of normal motor response without significant dyskinesia.

Methods: Participants from the Movement Disorder Clinic in Kingston Centre Melbourne, with motor fluctuations were recruited. The portable Parkinson Kinetigraph (PKG) was used to record dyskinesia, bradykinesia and fluctuations. The PKG was worn for 6 consecutive days on 2 specific occasions (Time 1- baseline measure on tablets, Time 2- once LCAS was titrated to achieve adequate levodopa response)). Other measures recorded were the MDS-UPDRS motor-ADL and motor scale and also the PDQ39.

Results: Fifteen males and one female participated in the study (mean age 69). The mean disease duration was 10.3 years. The mean MMSE score was 27/30. Time 1 was completed by 16 participants and Time 2 by 11 participants. 5 participants withdrew from prior to Time 2. No difference was found between the oral tablets (Time 1) and fully titrated LCAS (Time 2) on the PKG measures of bradykinesia, dyskinesia and fluctuations. However, there was significant improvement in the PDQ39 and UPDRS-motor ADL score.

Conclusions: The discrepancy between the significant changes in non PKG scores and the PKG measures maybe due to the small sample size or the lack of sensitivity of the PKG measures. Overall, the PDQ39 and the ADL improvements do suggest benefit of LCAS and further investigation using a larger sample size is warranted.

References: 1. Kurth et al. Oral levodopa/carbidopa solution versus tablets in Parkinson’s patients with severe fluctuations: a pilot study. Neurology 1993; 43(5):1036.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/liquid-sinemet-in-the-management-of-complex-motor-fluctuations-in-advanced-parkinsons-disease/