Objective: To assess the utility of Personal KinetiGraph (PKG) devices to objectively quantify difference in motor symptoms and motor fluctuations before and after the initiation of continuous enteral infusion therapy with carbidopa/levodopa (CD/LD) gel formulation.

Background: Continuous enteral infusion therapy with CD/LD is an alternative to DBS for patients with Parkinson’s disease (PD) suffering from motor fluctuations associated with oral CD/LD. A PKG device is a wrist-worn accelerometer used to quantitatively assess a patient’s motor fluctuations and objectively judge the efficacy of a therapeutic intervention.

Methods: Two patients wore the PKG device for 6 days prior to the initiation of and 6 days after a 3-month titration period of enteral CD/LD. PKG measures included in the assessment were: bradykinesia score (BK), dyskinesia score (DK), motor fluctuation score (FDS), percent time with immobility (PTI), and percent time with tremor (PTT).

Results: Patient 1 was a 61 year-old with 6 years of PD and Patient 2, a 70 year-old with 25 years of PD. Patient 1’s PKG scores before and after intervention were as follows: BK 29.4 to 21.9, DK 1.1 to 1.7, FDS 6.8 to 9.8, PTI 4.2% to 2.5%, and PTT 0.1% to 0.3%. Patient 2’s PKG scores were as follows: BK 23.5 to 25.8, DK 0.6 to 0.6, FDS 8.9 to 8.6, PTI 10.4% to 12.4%, and PTT 3.2% to 5.3%. Subjectively, Patient 1 developed mild dyskinesias and Patient 2 more bothersome dyskinesias post therapy. Both patients had resolution of FOG, improved quality of life and improvement in motor fluctuations.  These subjective results were not fully reflected in the objective PKG results.

Conclusions: The experience of our 2 patients supports the efficacy of continuous enteral infusion therapy with CD/LD to improve motor fluctuations, including FOG, and to improve quality of life. These positive results were not entirely reflected in the quantitative PKG scores. Patient 1 noted mild dyskinesias and the PKG device noted an increase DK. Patient 2 noted moderate dyskinesias and the PKG device noted no change in DK, but an increase PTT, which may have reflected a misrepresentation of ongoing dyskinesias. Our small sample size does not allow for a generalization of the utility of PKG to assess motor improvement after the initiation of a therapy, but does reinforce the importance of a patient’s subjective assessment and the objective clinic exam in assessing a therapeutic response.

References: 1. Hauser R. Levodopa: Past, Present, and Future. European Neurology. 2009; 62:1-8.

2. Horne M, McGregor S, Bergquist F. An Objective Fluctuation Score for Parkinson’s Disease. PLoS ONE. 2015; 10(4):e0124522.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/personal-kinetigraph-devices-assessing-efficacy-of-continuous-enteral-carbidopalevodopa-infusion-therapy/