Objective: To analyse the clinical profile and outcomes of patients with Parkinson’s Disease (PD) on combination Device-Aided Therapies (DAT) of Deep Brain Stimulation (DBS) and subsequent Continuous Subcutaneous Foslevodopa/foscarbidopa Infusion (CSFLI) therapy.

Background: PD patients may have suboptimal benefit with DBS due to multiple factors namely inadequate lead placement, chronic stimulation side effects and disease progression. The recently approved CSFLI therapy improves dopaminergic responsive symptoms and may be considered in these cases.

Method: Retrospective review of charts in two reference Movement Disorders centres of PD patients who had undergone DBS and were later initiated on CSFLI. Data analysed included demographic details and time to initiation of DATs. Clinical outcomes considered were change in duration of daily OFF time and bothersome dyskinesia. Data was analysed using appropriate statistical tools.

Results: We identified thirteen patients (M:F 12:1) on combination DATs. Mean age at diagnosis of PD was 51.5 (±7.6) years and at DBS surgery was 61.5 (±8.1) years, respectively. Indications for CSFLI were increased OFF time duration in 13/13 patients and bothersome dyskinesia in 2/13. At start of CSFLI, mean time since PD diagnosis was 15.9 (±5.5) years and since DBS start was 5.8 (±4.4) years. Mean levodopa equivalent daily dose (LEDD) before DBS was 1455.7 (±709.0) mg and before CSFLI was 1712.5 (±623.3) mg[GC1] [SG2] . After CSFLI, mean OFF time per day significantly reduced from 6.2 (±3.8) hours to 2.6 (±3.5) hours per day (T = 0, Z = −3.18, p < .01) and mean duration of bothersome dyskinesia per day reduced from 2.2 (±3.6) hours to 1.9 (±2.5) hours but was not statistically significant (T = 17.5, p = .92, n = 8). Mean follow up after CSFLI start was 6.6 (±4.9) months. Two (15.4%) patients discontinued CSFLI due to skin infection or nodule formations[GC3] [SG4] . One patient died due to systemic issues.

Conclusion: CSFLI use in PD patients with suboptimal benefits after DBS can significantly reduce the total daily OFF time. CSFLI therapy could also possibly reduce bothersome dyskinesia duration leading to better symptom control and functional outcomes. Further studies with larger patient samples are needed to validate these results.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/combination-device-aided-therapy-in-parkinsons-disease/