Objective: To examine the efficacy and safety of LCIG in a ‘real world’ tertiary care center setting in patients with and without DBS.
Background: Levodopa-Carbidopa Intestinal Gel Therapy (LCIG) is a well-established treatment for the management of motor fluctuations in advanced Parkinson’s disease (PD). However, there is a paucity of studies examining LCIG in a ‘real world’ setting that includes patients with deep brain stimulation (DBS) devices.
Method: All patients who had LCIG therapy from May 2015 to June 2020 at our institution were included in this study, including patients with existing DBS devices and those with dementia. Data was retrospectively collected through chart review. Efficacy was determined based on change in Clinical Impression of Severity Index for Parkinson’s Disease (CISI-PD) from baseline to 6 months following LCIG procedure.
Results: Thirty-six subjects, age 69 ±8 years (male 67%) were included. Median disease duration was 14 years and median duration of therapy was 16 months. Nine (27%) patients had existing DBS devices at the time of LCIG implantation. In all subjects, CISI-PD improved from 13 to 11 (p<.0001) at 6 months post-LCIG placement. This remained consistent in those without DBS (p < .0001) and those with DBS (p <.002). There was no significant difference in the degree of improvement between the DBS and non-DBS group. The total number of PD pills was reduced from 2.4 to 1.4 (p<.0001) and frequency of pills was reduced from 9 to 2 times per day (p<.0001) at 6 months. 81% of patients had at least one device-related complication. There were 6 deaths throughout the duration of this study, but none were related to the procedure.
Conclusion: In this large single center ‘real world’ study, LCIG therapy resulted in highly significant improvement in PD symptoms. While device related complications were common, no patient experienced a serious adverse event due to the procedure. There was no difference in improvement in the DBS vs non-DBS groups indicating LCIG as a viable option for patients with DBS experiencing disabling motor fluctuations despite DBS.
To cite this abstract in AMA style:P. Dole, S. Green, M. Wiggins, J. Joseph, M. Gaspari, M. Siddiqui. Levodopa-Carbidopa Intestinal Gel Therapy for Advanced Parkinson’s Disease: A Single Center ‘Real World’ Study of Patients with and without DBS [abstract]. Mov Disord. 2021; 36 (suppl 1). https://www.mdsabstracts.org/abstract/levodopa-carbidopa-intestinal-gel-therapy-for-advanced-parkinsons-disease-a-single-center-real-world-study-of-patients-with-and-without-dbs/. Accessed December 7, 2023.
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MDS Abstracts - https://www.mdsabstracts.org/abstract/levodopa-carbidopa-intestinal-gel-therapy-for-advanced-parkinsons-disease-a-single-center-real-world-study-of-patients-with-and-without-dbs/