Parkinson's disease is the second most common neurodegenerative disorder around the world. Levodopa has remained the "gold standard" of the therapy even several decades after its introduction. Chronic levodopa treatment is associated with the development of motor complications in most patients. Advanced Parkinson's disease is characterized by these complications: motor and non-motor fluctuation and disturbing dyskinesia. Continuous dopaminergic stimulation might reduce these complications. In advanced Parkinson's disease levodopa is still effective. In the treatment of this stage there are several advanced or device-aided therapies: apomorphine pump, deep brain stimulation and levodopa/carbidopa intestinal gel. Levodopa/carbidopa intestinal gel is an aqueous gel that can be delivered to the jejunum via a percutaneous gastrojejunostomy tube which is connected to an infusion pump dosing the levodopa gel continuously to the place of absorption. Levodopa/carbidopa gel infusion can be used as monotherapy, can be tested, can be used individually and this therapy is reversible. Several clinical trials demonstrated that levodopa/carbidopa intestinal gel therapy is of long-term benefit, improves the quality of life of the patients and can reduce motor fluctuation and dyskinesia.
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Comparison of Efficacy and Safety of Device-Based Interventions Versus Pharmacological Therapy in the Management of Patients With Advanced Parkinson's Disease: A Literature Review.
Cureus
December 2024
College of Medicine, Almaarefa University, Riyadh, SAU.
Parkinson's disease (PD) is a progressive neurodegenerative disorder characterized by motor and non-motor symptoms that profoundly impact patients' quality of life. While pharmacological therapies such as levodopa remain the mainstay of treatment, their long-term use is often limited by motor complications. Device-based interventions, including deep brain stimulation (DBS) and continuous dopaminergic infusions, have emerged as alternatives, promising sustained symptomatic control and reduced medication-related side effects.
View Article and Find Full Text PDFLong-term effect and reasons for switching and combining device-aided therapies in Parkinson's Disease.
Neurol Neurochir Pol
January 2025
Department of Neurology, University Medical Centre Ljubljana, Ljubljana, Slovenia.
Introduction: In the advanced stages of Parkinson's disease (PD), when standard drug adjustments fail to sufficiently improve patients' quality of life, device-aided therapies (DATs) such as deep brain stimulation (DBS), continuous subcutaneous apomorphine infusion (CSAI), levodopa-carbidopa intestinal gel infusion (LCIG), levodopa-carbidopa-entacapone intestinal gel infusion, or continuous subcutaneous foslevodoa-foscarbidopa infusion are beneficial in the long run. However, sometimes patients need to switch or combine DATs due to either adverse events or loss of efficacy.
Aim Of Study: The aim of this article was to summarise the existing data on the long-term efficacy and adverse events of DATs, and to review the data on the rationale and efficacy for switching or combining DATs in advanced PD.
How well is the female population represented in clinical trials with infusion therapies for Parkinson's disease? A systematic review and metanalysis.
Eur J Neurol
January 2025
Parkinson and Movement Disorders Unit, Study Center for Neurodegenerative diseases (CESNE), Department of Neuroscience, Padua Neuroscience Center (PNC), University of Padua, Padua, Italy.
Background: Parkinson's disease (PD) is a neurodegenerative disorder affecting both sexes, but differences exist between male and female in clinical manifestations, functional impact of symptoms and hormonal influences. Therefore, representativeness of females in PD trials indirectly determines the external validity of the clinical research in this field.
Objective: To estimate the representativeness of female in infusion therapy trials for advanced PD.
Levodopa Pharmacokinetics in Switching from Levodopa/Carbidopa Intestinal Gel to Continuous Subcutaneous Foslevodopa/Foscarbidopa Infusion in a Patient with Parkinson's Disease: a case report.
J Mov Disord
January 2025
Department of Neurology, Keio University School of Medicine, Tokyo, Japan.
Direct Initiation of Levodopa-Carbidopa Intestinal Gel Infusion After a Positive Levodopa Challenge Test in Advanced Parkinson's Disease.
Brain Behav
December 2024
Department of Neurology, Helsinki University Hospital, Helsinki, Finland.
Article Synopsis
- LCIG is a treatment for advanced Parkinson's disease, often starting with a nasojejunal tube (NJT) test phase, but some centers have initiated treatment directly with a PEG-J tube.
- A study compared these two methods in 33 advanced PD patients, evaluating treatment discontinuations, adverse events, and hospital stay length.
- Results showed no significant differences in complications or discontinuations between the two methods, but direct initiation with PEG-J reduced hospital stays significantly.
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