Objective: To report the use of levodopa-carbidopa intestinal gel (LCIG) as an additional therapy for the treatment of motor fluctuations in a patient with advanced idiopathic Parkinson’s disease (PD) on deep brain stimulation (DBS).
Background: LCIG and DBS have been established treatment modalities with proven efficacy for advanced PD (1). However, there is a paucity of data in the literature regarding their use in combination (2). While clinical deterioration had been reported as the main reason for using both in a case report (3), we highlight technical barriers during the COVID-19 era as a substantial drive.
Method: Our patient was a 66-year-old gentleman with idiopathic PD for nine years. That was successfully treated with unilateral DBS of the subthalamic nucleus. Due to the imposed COVID-19 travel restriction, routine replacements of impulse generators were not accessible in due time. Besides, with re-emerging of motor fluctuations and gait difficulties, the need had been identified for another more accessible add-on therapy at our center. After proper assessment, a PEG-J tube was inserted, LCIG infusion started, and the clinical response was measured pre and post LCIG.
Results: By combining both therapies, the patient instantly regained control of his motor fluctuations and a recorded sustained improvement in his gait and balance after eight months of follow-up. This was achieved by less than expected inputs of both devices.
Conclusion: Combining two different device-assisted therapies for advanced PD could be considered a promising choice. Large-scale-controlled studies are needed to fill the gaps in knowledge.
References: 1.van Poppelen D, Sisodia V, de Haan RJ, Dijkgraaf MGW, Schuurman PR, Geurtsen GJ, Berk AEM, de Bie RMA, Dijk JM. Protocol of a randomized open label multicentre trial comparing continuous intrajejunal levodopa infusion with deep brain stimulation in Parkinson’s disease – the INfusion VErsus STimulation (INVEST) study. BMC Neurol. 2020 Jan 31;20(1):40.
2.Regidor I, Benita V, Del Álamo de Pedro M, Ley L, Martinez Castrillo JC. Duodenal Levodopa Infusion for Long-Term Deep Brain Stimulation-Refractory Symptoms in Advanced Parkinson Disease. Clin Neuropharmacol. 2017 May/Jun;40(3):103-107.
3.Levodopa-Carbidopa Intestinal Gel (LCIG) in Deep Brain Stimulation (DBS) Parkinson’s Patients. Ahmad El Kouzi, Leonardo Almeida, Adolfo Ramirez Zamora, Pam Zeilman, Matthew Barabas, Irene Malaty, Michael Okun. Neurology Apr 2018, 90 (15 Supplement) P6.027;
To cite this abstract in AMA style:
M. Abu Al-Melh, M. Farghal, N. Abdelall. Levodopa-carbidopa intestinal gel (LCIG) as an add-on therapy to deep brain stimulation (DBS) for managing progressive symptoms of advanced idiopathic Parkinson’s disease during the COVID-19 pandemic: Case Report [abstract]. Mov Disord. 2022; 37 (suppl 2). https://www.mdsabstracts.org/abstract/levodopa-carbidopa-intestinal-gel-lcig-as-an-add-on-therapy-to-deep-brain-stimulation-dbs-for-managing-progressive-symptoms-of-advanced-idiopathic-parkinsons-disease-during-the-covid-19-p/. Accessed June 15, 2025.« Back to 2022 International Congress
MDS Abstracts - https://www.mdsabstracts.org/abstract/levodopa-carbidopa-intestinal-gel-lcig-as-an-add-on-therapy-to-deep-brain-stimulation-dbs-for-managing-progressive-symptoms-of-advanced-idiopathic-parkinsons-disease-during-the-covid-19-p/