Objective: To analyze the long-term retrospective data of patients treated with Levodopa/carbidopa intestinal gel infusion (LCIG) and subthalamic nucleus deep brain stimulation (STN-DBS) in two Movement Disorders specialized Centers, as compared with a disability-matched control group of patients who opted to continue oral medical therapy (OMT) after becoming eligible for STN-DBS.

Background: STN-DBS and LCIG can reduce the severity of motor complications and improve the activities of daily living (ADL) in advanced Parkinson’s disease through distinct mechanisms: LCIG stabilizes L-dopa plasma level fluctuations, while STN-DBS modulates pathologic basal ganglia oscillatory patterns. Their long-term comparability in safety and efficacy, however, remains unclear.

Methods: We reviewed the 5-year data on OFF time, dyskinesia duration and dyskinesia severity as measured per items 39, 32, and 33, respectively, of the Unified Parkinson’s disease Rating Scale (UPDRS) part IV in 60 PD patients exposed to STN-DBS (n=20), LCIG (n=20), and OMT (n=20) at similar baseline disability and cognitive state.

Results: There was similar reduction in OFF time for STN-DBS and LCIG-treated patients (-62.1% vs. -54.5%, p= 0.830) but greater improvement in dyskinesia duration (-66.1% vs. -9.0%; p= 0.004) and severity (-68.8% vs. -18.0%; p= 0.014) in STN-DBS than LCIG. OMT patients exhibited worse outcomes in all endpoints. The annualized complication rate was greater with LCIG (0.68) than STN-DBS (0.13) and OMT (0.10) (p< 0.001).

Conclusions: STN-DBS and LCIG showed comparable efficacy in OFF time, superior to OMT. However, STN-DBS yielded greater improvement on dyskinesia duration and severity and lower long-term rate of complications than LCIG.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/subthalamic-deep-brain-stimulation-vs-intraduodenal-levodopa-infusion-a-long-term-retrospective-comparative-study/