Objective: The primary objective of this study is to investigate the effect of continuous subcutaneous infusion (CSCI) of foslevodopa/foscarbidopa (FL/FC) on gait in those with Parkinson’s disease who switch from oral therapy.

Background: Gait disturbance in Parkinson’s disease (PD) can significantly impact patients’ quality of life¹ . Motor fluctuations may be reflected in real-life gait parameters². Advanced therapies, such as CSCI, can have a significant effect on motor fluctuations but their effect on gait parameters has not been previously studied. A subcutaneous FL/FC formulation has been recently approved for management of motor fluctuations and may potentially improve gait parameters in advanced PD patients by reducing “off” time and/or dyskinesias compared to oral therapies

Method: 17 participants (11 male: 6 female) have completed a standardised clinical assessment of gait and balance (Mini-BESTest) while taking conventional oral medication (baseline). They repeated the assessment 12 weeks post-commencement of CSCI FL/FC. Gait parameters, including, cadence (step/min), step time (s), stride cycle time (s) and gait cycle asymmetry (%) were extracted from the 3m Timed up and go (TUG), using high density insole pressure sensors (Tekscan, US). Gait parameters, pre- and post-CSCI, were compared through repeated measures ANOVAs.

Results: Results of baseline gait assessment revealed average cadence of 46.35 (±10.6), step time of 0.69s (±0.37), gait-cycle time of 1.37s (±0.36), stance-time of 0.92s (±0.4), swing time of 0.45s (±0.1) and gait asymmetry of 25% (range 4-75%). We present the changes in stride length, gait speed and symmetry following commencement of CSCI FL/FC intervention when compared with gait on oral therapies.

Conclusion: Continuous dopaminergic stimulation via pump therapies could have a positive impact on gait stability and consistency, compared to oral medication via a reduction in dyskinesia and bradykinesia. More stable gait will lead to fewer falls, greater confidence in walking and improved mobility-related quality of life for those living with Parkinson’s disease³.

References: 1. Kim SM, Kim DH, Yang Y, Ha SW, Han JH. Gait Patterns in Parkinson’s disease with or without Cognitive Impairment. Dement Neurocogn Disord. 2018 Jun;17(2):57-65. doi: 10.12779/dnd.2018.17.2.57. Epub 2018 Jul 24. PMID: 30906393; PMCID: PMC6427969.
2. L. Evers, J. Raykov, R. Badawy, K. Claes, M. Meinders, J. Krijthe, T. Heskes, M. Little, B. Bloem, Real-life gait performance as a marker for motor fluctuations: the Parkinson@home Validation study, Meeting: 2019 MDS International Congress, Abstract No. 861
3. Smith MD, Brazier DE, Henderson EJ. Current Perspectives on the Assessment and Management of Gait Disorders in Parkinson’s Disease. Neuropsychiatr Dis Treat. 2021 Sep 21;17:2965-2985. doi: 10.2147/NDT.S304567. PMID: 34584414; PMCID: PMC8464370.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/continuous-subcutaneous-dopaminergic-stimulation-exploring-the-impact-of-foslevodopa-foscarbidopa-on-gait-in-parkinsons-disease/