Session Information
Date: Tuesday, September 24, 2019
Session Title: Parkinsonisms and Parkinson-Plus
Session Time: 1:45pm-3:15pm
Location: Agora 3 West, Level 3
Objective: To evaluate the effect of continuous dopaminergic treatment with levodopa/carbidopa intestinal gel (LCID) on motor and non-motor symptoms in multiple system atrophy (MSA) patients.
Background: MSA is a neurodegenerative disease, characterized by progressive autonomic failure, parkinsonism, cerebellar and pyramidal features in various combinations. A proportion of MSA patients may show a partial and transient response of motor and non-motor symptoms to levodopa.
Method: We present three levodopa responsive MSA patients who had additional benefit from LCID treatment. Diagnosis of MSA was made by the presence of characteristic clinical features and further supported by typical brain MRI findings, abnormal DaTSCAN and characteristic changes on brain FDG-PET. The disease progression and treatment effect were ascertained by regular follow-ups, including clinical examination and ratings on motor and non-motor scales.
Results: A 53-year old female with six-years history of MSA-P was started on LCID in May 2017 due to wearing-off periods on oral levodopa. LCID improved her overall mobility, speech, tremor and painful dystonia. After 20 months of treatment, prominent worsening of pre-existing polyneuropathy was noted, possibly related to LCID. A 56-year old female with one-year history of MSA-P was started on LCID in March 2018, due to severe fluctuations of motor symptoms, pain and levodopa related dystonic dyskinesias. Low dose of LCID relatively satisfactorily ameliorated her bradyhypokinesia, while reducing dyskinesias. There was also a sustainable effect of LCID on pain. A 66-year old female was diagnosed with MSA-C seven years before LCID treatment in June 2018. Oral levodopa improved her pain and sleep, but the effect was wearing off after 2 hours. With LCID, she reported reduction of daytime pain with favourable effect on sleep.
Conclusion: Although LCID is not a standard treatment option for atypical parkinsonism, it may be effective for selected MSA patients who are responsive to levodopa, but show fluctuations of motor and non-motor symptoms and levodopa related dyskinesias. However, effect may be hampered by worsening of pre-existing polyneuropathy or emergence of LCID induced polyneuropathy.
To cite this abstract in AMA style:
S. Delalic, S. Ibrulj, N. Zupancic, D. Flisar, M. Trost, Z. Pirtosek, M. Kojovic. Continuous dopaminergic treatment with levodopa/carbidopa intestinal gel in multiple system atrophy: report of three patients [abstract]. Mov Disord. 2019; 34 (suppl 2). https://www.mdsabstracts.org/abstract/continuous-dopaminergic-treatment-with-levodopa-carbidopa-intestinal-gel-in-multiple-system-atrophy-report-of-three-patients/. Accessed May 17, 2025.« Back to 2019 International Congress
MDS Abstracts - https://www.mdsabstracts.org/abstract/continuous-dopaminergic-treatment-with-levodopa-carbidopa-intestinal-gel-in-multiple-system-atrophy-report-of-three-patients/