Objective: To describe two cases of patients with Parkinson’s disease (PD) where deep brain stimulation (DBS) was used a rescue therapy when duodenal levodopa infusion (LCIG) could not manage motor symptoms adequately.

Background: When motor complications become disabling in PD, device-based therapies can be used including LCIG and DBS. LCIG can provide benefit for motor fluctuations and dyskinesias, but the benefit may not be sustained long-term. There are cases reported of patients being treated with LCIG after DBS, but not transition from LCIG to DBS.

Method: Case 1 (published previously) is a 63-year-old man with an 18-year history of PD who had been on LCIG for 2 years. He had 25% off time of waking hours and experienced significant dyskinesias that impacted his gait and balance. His UPDRS-III score was 30 when ON LCIG. He therefore underwent bilateral STN DBS. Case 2 is a 66-year-old man with a 10-year history of PD who had been on LCIG for 2 years where he was experiencing motor fluctuations and dyskinesias for 25% of the day with worsening left distal lower limb dyskinesia and dystonia. His UPDRS-III score was 23 when ON LCIG. He underwent bilateral GPi-DBS to help with the dyskinesias and dystonia.

Results: In both cases, DBS programming began 4 weeks post-operatively at which time LCIG was discontinued. For Case 1, dyskinesias improved significantly post-DBS; five months post-DBS surgery, UPDRS-III improved to 14. At last follow-up 2 years post-DBS surgery, UPDRS-III was 17 ON medications/ON stimulation. For Case 2, at follow-up 6 months post-DBS surgery, UPDRS-III was 22 ON medications/ON stimulation and he reported improvement in both tremor and dystonia.

Conclusion: These two cases demonstrated that transition from LCIG to DBS is a suitable option in PD patients experiencing suboptimal benefit with LCIG treatment.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/deep-brain-stimulation-as-a-rescue-when-duodenal-levodopa-infusion-fails-report-of-2-cases/