Session Information
Date: Thursday, June 23, 2016
Session Title: Parkinson's disease: Clinical trials, pharmacology and treatment
Session Time: 12:00pm-1:30pm
Location: Exhibit Hall located in Hall B, Level 2
Objective: To determine whether levodopa-carbidopa intestinal gel (LCIG) infusion is able to improve freezing of gait (FOG) in advanced Parkinson’s disease (PD) patients.
Background: FOG is a common and disabling problem in advanced PD. The constant dopaminergic drug delivery obtained by LCIG infusion allows a significant reduction of motor fluctuations and dyskinesia in patients with advanced PD. There is preliminary evidence that in selected patients, LCIG treatment may improve FOG refractory to oral dopaminergic therapy.
Methods: We retrospectively evaluated the effects of LCIG in a group of 36 consecutive PD patients treated at our centre between 2005 and 2015. Clinical assessments were performed before starting LCIG (both in “OFF” state, following overnight withdrawal of all antiParkinsonian medications, and “ON” state, after a challenge with 1.5X the usual levodopa morning dose) and during “daily ON” with LCIG infusion. The main outcome measures were changes in FOG related UPDRS subscore, UPDRS motor and axial score, motor complications, Hoehn & Yahr (HY) stage and levodopa equivalent daily dose (LEDD). Preoperative characteristics of patients with and without FOG improvement were compared.
Results: Patients were followed for a mean of 36.83±21.73 months during which a progression of disease was evident (HY ON medication score deteriorated 16%; p=0.004). LEDD was unchanged (p=0.437). There was a 63% reduction of daily OFF periods (p=0.001) and a 28% reduction in daily dyskinesia duration (p=0.008). FOG related UPDRS subscore improved 29.2% in ON condition (p=0.011) and 30.9% in OFF condition (p=0.001). FOG improved in 14 (38.9%) patients, it was unchanged in 18 (50%) and it worsened in 4 (11%). Patients with FOG improvement had worse FOG score ON medication, worse motor and axial symptoms ON medication, and a shorter duration of motor complication at LCIG initiation compared to patients with no change or worsening of FOG during LCIG.
Conclusions: Our data support the notion that in selected patients, LCIG treatment may improve FOG refractory to oral dopaminergic therapy. LCIG may thus be a useful therapeutic strategy to consider when FOG unresponsive to conventional oral treatment is present in advanced PD patients.
To cite this abstract in AMA style:
M. Zibetti, S. Angrisano, F. Dematteis, A. Romagnolo, A. Merola, L. Lopiano. Improvement of freezing of gait with intestinal levodopa infusion in advanced Parkinson’s disease patients [abstract]. Mov Disord. 2016; 31 (suppl 2). https://www.mdsabstracts.org/abstract/improvement-of-freezing-of-gait-with-intestinal-levodopa-infusion-in-advanced-parkinsons-disease-patients/. Accessed June 14, 2025.« Back to 2016 International Congress
MDS Abstracts - https://www.mdsabstracts.org/abstract/improvement-of-freezing-of-gait-with-intestinal-levodopa-infusion-in-advanced-parkinsons-disease-patients/