Objective: To assess the safety and efficacy of carbidopa/levodopa enteral suspension (CLES) in Parkinson’s disease (PD) patients with cognitive impairment.

Background: As Parkinson’s Disease progresses, patients treated with levodopa frequently experience fluctuations from an ON state to an OFF state which can be complicated to effectively manage. Recently, a new formulation of levodopa has been developed, an enteral suspension for treatment of PD patient with motor fluctuations. There are no data regarding the safety and efficacy of initiation of CLES in patients with cognitive impairment.

Methods: PD patients from the University of Kansas Movement Disorder Database whom were initiated on CLES therapy and had MoCA scores less than 23 were selected. Demographics and UPDRS were collected at baseline, 6 months, and/or 12 months.

Results: Ten PD patients (6 men/4 women) with a mean age at time of surgery of 74.1 years (range 62.9-88.9) and a mean disease duration of 13.5 years (range 3.5 to 23) were initiated with CLES. The baseline mean MoCA score was 17.3 (range 8-22). The baseline mean UPDRS Mentation score was 4.1 (range 0-10), UPDRS ADL score was 25.1 (range 13-45), mean UPDRS Motor score was 33.7 (range 21-49). At this time, four patients have follow-up data. At 6 months (n=3), the mean UPDRS Mentation score improved by 1.4 points, the mean UPDRS ADL score improved by 8.8 points, and the mean UPDRS Motor score improved by 7.2 points. At 12 months (n=2), the mean UPDRS Mentation score worsened by 0.4 points, the mean UPDRS ADL score worsened by 3.9 points, and the mean UPDRS Motor score improved by 4.4 points. As measured by the UPDRS Part IV, dyskinesia increased in 3 patients and was unchanged in 1 patient; however, OFF time was reduced in 3 of the 4 patients. All 4 patients reported marked improvement at all follow up visits per the patient global impression of change. Complications occurred in 9 of 10 patients and included: small perforation during placement requiring an open procedure (n=1), malfunctioning J-tube including accidental displacement (n=2), kinked tube (n=2) and occluded tube (n=1), cellulitis[KL1]  (n=3), and replacing pump 4 times (n=1).

Conclusions: CLES therapy can safely be initiated in Parkinson’s disease patients with cognitive impairment; however complications were common. Preliminary results suggest improvements in quality of life and motor outcomes.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/clinical-experience-with-initiation-of-carbidopalevodopa-enteral-suspension-in-parkinsons-disease-patients-with-cognitive-impairment/