Objective: To investigate the short term effect of liquid sinemet on the non-motor symptoms of people with advanced Parkinson’ disease (PD) who experience complex motor fluctuations.

Background: The prevalence of non-motor symptoms in PD is reported to be as high as 97% 1. As the disorder progresses so do many of the non-motor symptoms. Advanced disease also sees a decline in the response to oral PD medications, resulting in motor fluctuations and unpredictability of motor response. This unpredictability in response is also associated with fluctuating non-motor symptoms that, along with the motor fluctuations, may lead to a loss of independence and a decline in quality of life. Fluctuations in motor response can be complex and may be refractory to tablet formulations of levodopa. In such cases, neurologists at the Kingston Centre, Melbourne, routinely trial levodopa in solution (levodopa/carbidopa/ascorbic acid solution or LCAS). LCAS preparations consist of a soluble solution of 1 mg/ml of levodopa administered hourly during the person’s waking day 2. The effect of LCAS on non-motor symptoms has not been reported.

Methods: This one group pre-test – post-test study included sixteen participants with complex motor fluctuations that could not be adequately managed with tablet formulations of levodopa. The main outcome was the change in the Non-Motor Symptoms Questionnaire (NMSQuest) score from baseline, when participants were taking their usual PD tablet formulations, to completion of LCAS dose titration. Secondary outcomes included depression and quality of life.

Results: Five participants prematurely discontinued LCAS. The remaining 11 participants showed a significant improvement in NMSQuest scores (p = 0.04), depression (p=0.01) and quality of life (p=0.001).

Conclusions: This study provides evidence for the short term effectiveness of LCAS in the management of non-motor symptoms in PD. Liquid sinemet is a low cost, non-invasive and easily administered formulation of levodopa that can be micro-adjusted to provide maximum consistent benefit.

References: 1. Martinez-Martin et al. Prevalence of nonmotor symptoms in Parkinson’s disease in an international study. Mov Disord 2007;22:1623. 2. 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/efficacy-of-liquid-sinemet-on-non-motor-symptoms-in-parkinsons-disease/