Objective: We report the effective treatment of troublesome dyskinesias in Parkinson’s disease (PD), unresponsive to 16-hour daytime infusions, using 24-hour Levodopa/Carbidopa Intestinal Gel (LCIG).

Background: Continuous 16-hour per day intra-jejunal infusion of LCIG is an effective advanced therapy in the treatment of Parkinson’s disease (PD) associated with motor fluctuations, including troublesome dyskinesias in many patients(1). We describe our use of 24-hour LCIG in the treatment of severe dyskinesias inadequately controlled with daytime infusion.

Methods: We conducted a retrospective review of all patients treated with 24-hour LCIG for the treatment of dyskinesia within our centre. Data for patients with contemporaneous objective dyskinesia ratings before and after 24 hour LCIG transition were also included in the analysis. Side effects, total 24 hour dose, and LCIG infusion rates were compared before and after transition to 24 hour therapy and at most recent follow up.

Results: 26 PD patients were identified who had received treatment with 24 hour LCIG. 10 were receiving 24 hour LCIG for the treatment of dyskinesia, 9 with follow-up data available.  3 patients with objective ratings of dyskinesia severity and frequency after transition to 24-hour LCIG for another indication were identified. The mean age at the time of transition to 24 hour LCIG was 68.9 years (range 51-81), duration of PD 17.9 years (range 11-30). 10/12 patients were male. None of the patients analysed had a worsening of dyskinesia following use of 24hour LCIG. Following transition to 24 hour LCIG, 9 patients had an improvement in dyskinesia with mean reduction of 1.3 points in both UPDRS 4.1 and 4.2 scores (range 1-3). In 7 of these patients this was observed despite an overall increase in the 24 hour levodopa dose, in 4 of which there was an increase or no change in the daytime continuous rate.  One patient transitioned back to 16-hour LCIG because of side-effects.

Conclusions: 24-hour LCIG offers an effective treatment option for troublesome dyskinesia in advanced PD. The therapy was well-tolerated within this patient group, despite overall increases in LCIG dose in the majority of patients. The reduction in dyskinesia despite increase in 24 hour dose and, in many patients, maintenance of similar daytime rates, suggests a pharmacodynamic mechanism over and above improvements mediated via pharmacokinetic benefits in LCIG therapy.   

References: Antonini, Angelo, et al. “Effect of levodopa‐carbidopa intestinal gel on dyskinesia in advanced Parkinson’s disease patients.” Movement Disorders (2016).

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MDS Abstracts - https://www.mdsabstracts.org/abstract/managing-severe-dyskinesia-in-parkinsons-disease-using-24-hour-levodopacarbidopa-intestinal-gel-infusion/