Objective: To describe the first evidence of dual therapy with deep brain stimulation (DBS) and foslevodopa/foscarbidopa (LDp/CDp) subcutaneous infusion treating Parkinson´s disease (PD).

Background: In patients with fluctuating PD, deviced-aided therapies like DBS or LDp/CDp subcutaneous infusion can alleviate symptoms.

There is plenty evidence on both therapies separately or one treatment as a bridge therapy to the other one. However, in our knowledge, there is no published scientific evidence on this dual therapy.

Method: Description of the management of 2 patients who had partial control of fluctuations with DBS and due to incomplete control of disabling symptoms, LDp/CDp subcutaneous infusion was added, maintaining both treatments.

Results: PATIENT A: male, 52. Started at 39 with left tremulous PD. 5 years after fluctuations and dyskinesias started, therefore bilateral DBS in subthalamic nucleus (STN) was performed. Despite different brain stimulator settings and oral medication adjustments, some unpredictable symptoms such as freezing of gait and disabling dyskinesias persisted. Because of the gait abnormalities improved during the levodopa test, we decided to decrease the amplitude of unilateral DBS to prevent dyskinesias and establish a LDp/CDp infusion. The gait improved partially, allowing the patient to have a better quality of life.

PATIENT B: male, 56. PD was diagnosed at 34. Bilateral STN DBS was done at 44, due to fluctuations. At 54 patient had a small therapeutic margin because he had unpredictable episodes with rigidity and freezing of gait, which improved with oral treatment, but caused him severe dyskinesias. DBS settings either caused dyskinesias or were not tolerated. A low of rate LDp/CDp was tolerated, reduced the number and severity of fluctuations and improved dyskinesias.

Conclusion: DBS has proven efficacy treating symptoms such as tremor, bradykinesia and rigidity, but it is common for some patients undergoing DBS to also use oral levodopa in order to control symptoms. But the pulsatile administration of levodopa can cause disabling dyskinesia. Therefore, we present the first evidence of dual therapy (DBS and LDp/CDp) in patients in whom maintaing both treatments improved their OFF symptoms and dyskinesias.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/first-reported-experience-of-dual-therapy-with-deep-brain-stimulation-and-foslevodopa-foscarbidopa-subcutaneous-infusion/