Is continuous levodopa-carbidopa infusion effective in people with severe dyskinesia?

This study looked at the use of levodopa-carbidopa intestinal gel (LCIG; Duodopa) for the treatment of severe dyskinesia in patients with advanced Parkinson's disease (PD). It found that LCIG improved symptoms in most patients but that dose adjustments were needed throughout treatment.

Parkinson's disease (PD) is usually treated with a levodopa-carbidopa combination. The medication can be administered by mouth or through the skin. However, over time this treatment becomes less effective. This can result in severe dyskinesia due to the uneven release of medication. Dyskinesia is the name used for involuntary movements of the body such as jerks and spasms and it can have a big impact on patients' quality of life.

Another newer way to deliver levodopa–carbidopa is directly to the intestines. LCIG treatment involves giving levodopa-carbidopa straight into the intestines as a continuous infusion. It is delivered with a pump through a small opening on the abdomen that is made in an outpatient procedure.

Patients with more advanced PD commonly have more severe dyskinesia. It is not clear if LCIG improves severe dyskinesia in patients with advanced PD. 

34 patients with advanced PD were included in this study. All patients had severe dyskinesia, lasting at least 30 minutes on most days. Patients were treated with LCIG infusions every day, lasting 16-24 hours. Symptoms were monitored via questionnaires at the start and after 6, 12 and 18 months of treatment.  

After LCIG treatment, symptoms of severe dyskinesia were significantly reduced. This reduction in symptoms lasted for 18 months of follow-up. Over time, most patients needed longer hours of LCIG infusion to control their symptoms. By 18 months, 16 out of 34 patients were on LCIG infusions 24 hours per day.

This study showed that LCIG infusion is an effective treatment for patients with severe dyskinesia, who are not controlled with standard treatment.  

This study was based on medical records. Some information might have been missing. Also, the number of participants was small. Further studies are needed to confirm these findings.