Objective: To describe our experience with dual device-aided therapies (DATs).
Background: DATs for advanced Parkinson’s disease (PD) include deep brain stimulation, continuous subcutaneous apomorphine infusion (CSAI), levodopa-carbidopa intestinal gel infusion (LCIG) and levodopa-entacapone-carbidopa intestinal gel (LECIG). Continuous subcutaneous foslevodopa/foscarbidopa infusion (CSFLI) is the most recently approved DAT. While evidence for combining DBS with LCIG or CSAI is growing, the combination of DBS with CSFLI has not been prospectively studied.
Method: We retrospectively reviewed patients with advanced PD treated with bilateral deep brain stimulation of the subthalamic nucleus (STN-DBS) and CSFLI at our Movement Disorders Unit.
Results: Three male patients (age at PD diagnosis: 32, 40 and 55 years) with bilateral STN-DBS were identified. CSFLI was added after 8, 8 and 10 years of DBS, respectively. Indications for CSFLI were: refractory freezing of gait unresponsive to DBS optimisation (n=1), disabling OFF periods (n=1) and refractory dyskinesias (n=1). At time data collection, dual therapy had been ongoing for 12, 15 and 17 months. MDS-UPDRS-III improved in all three patients following CSFLI addition: −49% (41-21 points), −39% (28-17 points) and −21% (34-27 points). LEDD changes were heterogeneous: a reduction of 26% was observed in the patient with disabling OFF periods (1,321→983 mg/day), while LEDD increased in the remaining two patients. Two of three patients reported subjective global improvement. No serious device-related or drug-related adverse events attributable to the combination were recorded. Neither DBS nor CSFLI was withdrawn in any patient during the follow-up period.
Conclusion: We report, to our knowledge, one of the first case series describing the combination of bilateral STN-DBS and CSFLI in patients with advanced PD. Motor improvement was observed in all patients, supporting the rationale for combining neuromodulation with continuous dopaminergic delivery when a single DAT is insufficient. Larger multicentre studies are needed to assess the long-term efficacy and safety of this novel combination strategy.
To cite this abstract in AMA style:
C. Ribacoba Díaz, A. Fernández Revuelta, A. Aldaz Burgoa, E. López Valdés, R. García-Ramos García. Dual device-aided therapy in advanced Parkinson’s Disease: combining bilateral deep brain stimulation and continuous subcutaneous foslevodopa/foscarbidopa Infusion [abstract]. Mov Disord. 2026; 41 (suppl 1). https://www.mdsabstracts.org/abstract/dual-device-aided-therapy-in-advanced-parkinsons-disease-combining-bilateral-deep-brain-stimulation-and-continuous-subcutaneous-foslevodopa-foscarbidopa-infusion/. Accessed October 1, 2026.« Back to 2026 International Congress
MDS Abstracts - https://www.mdsabstracts.org/abstract/dual-device-aided-therapy-in-advanced-parkinsons-disease-combining-bilateral-deep-brain-stimulation-and-continuous-subcutaneous-foslevodopa-foscarbidopa-infusion/