Objective: To evaluate the profile of those patients with advanced Parkinson’s Disease (APD) in which we decided to use continuous 24-hour administration of Levodopa Carbidopa Intestinal Gel (LCIG), to obtain adequate control of motor and non-motor complications.

Background: The efficacy and safety of 16-hours administration of LCIG in reducing motor fluctuations and ameliorating different non-motor symptoms has been established. Additional benefits of 24-hour LCIG administration have been reported in several case series and small clinical studies. The main indications for 24-hour LCIG are: severe night-time and/or early morning akinesia, unresponsive freezing of gait, troublesome dyskinesias and dystonias, and sleep fragmentation/poor sleep quality.

Method: We performed a retrospective evaluation of 62 APD cases in which, due to unsatisfactory initial clinical benefits, continuous 24-hour LCIG was deemed necessary.

Results: Patients treated with 24-hour LCIG had an average age of 65.1±7.4 years (mean±SD) and an average disease duration of 11.3±4.7 years. They presented 4.8±1.2 hours OFF duration and 39 of them (63%) presented also 3.0±1.0 hours dyskinesias. The overwhelming majority (58 cases, 94%) presented severe early morning akinesia. 41 patients (66%) experienced delayed ON and 19 (31%) had no ON also. Sudden OFF was present in 30 cases (48%) and freezing in 40 cases (65%).

Conclusion: Wake hours/daytime LCIG does not always sufficiently improve the patient’s quality of life in some patients, mainly due to persistent nighttime troublesome symptoms. Instead of labeling the patient as a non-responder it is worth trying the 24-hour LCIG dosage in a carefully selected group of patients. The initiation of the 24-hour LCIG treatment should be decided individually, after considering the potential benefits and disadvantages.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/initial-24-hours-levodopa-carbidopa-intestinal-gel-initiation-in-advanced-parkinsons-disease/