Objective: To present a case of Parkinson’s disease (PD) whose daily levodopa/carbidopa intestinal gel (LCIG) dose has been determined by her spouse and prevented long-term fluctuations.

Background: LCIG (carbidopa/levodopa enteral suspension) has been widely used and studied for the treatment of motor fluctuations in levodopa-responsive patients with advanced-stage PD when other treatments have not given satisfactory results. It has been used since 2004 in Europe and since 2016 in Japan. It is still difficult to determine daily LCIG dose in some patients with severe motor fluctuations.

Method: We present a 77-year-old female Japanese PD patient with 28-year history since the disease onset. She admitted to our hospital because of severe wearing off, peak-dose and diphasic dyskinesias, and LCIG was introduced. Two years later, we asked her spouse, who was very intelligent, to determine her daily LCIG dose, because she had some day-to-day and long-term motor fluctuations. Her spouse kept a detailed diary of patient’s symptoms and made the graphs of changes in the daily LCIG dose.

Results: Daily LCIG continuous dose first decreased and then increased gradually between 3.0ml (levodopa 60mg)/hr and 3.8ml (levodopa 76mg)/hr within two months [Fig. 1]. Other medications, that were droxidopa 900mg and rotigotine 13.5mg, were not changed. Throughout this period, her symptoms were generally stable.

Conclusion: Patients with PD sometimes experience long-term fluctuations possibly due to temperature change, stressful situations, and bad health condition other than PD, even when medication is not changed. In this patient, careful LCIG dose change by the family member might prevent long-term fluctuations.

Fig. 1

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MDS Abstracts - https://www.mdsabstracts.org/abstract/a-case-of-parkinsons-disease-whose-daily-levodopa-carbidopa-intestinal-gel-dose-has-been-determined-by-her-spouse-and-prevented-long-term-fluctuations/