Initial Experience with Levodopa Intestinal Gel for Advanced Parkinson’s Disease

Background: Continuous infusion of Levodopa/Carbidopa Intestinal Gel (LCIG) by a portable pump, directly to the duodenum, via Percutaneous Endoscopic Gastrojejunostomy (PEG) is a new treatment option for patients with advanced Parkinson’s disease (PD) that has recently become available in Israel. Objectives: To report our initial experience concerning, efficacy, safety and feasibility of LCIG treatment Methods: Consecutive patients with advanced PD experiencing motor fluctuations despite optimized pharmacologic therapy or deep brain stimulation were included. Clinical assessments included the Unified PD Rating Scale (UPDRS), the Clinical Global Impression of Change (CGI-C), and patient and caregiver interview. Results: Between January 2012 and August 2013, 17 PD patients went through the first treatment phase (LCIG titration via a naso-duodenal tube); ten of them (6 males, age 67.3±9.5 years, range 55-87, PD duration 16.1±5.8 years) proceeded to PEG placement and permanent treatment phase. The mean follow-up time was 11.1±8.5 months (range 3-22 months). Five patients had an improvement of at least 25% in the motor “on” UPDRS score. All patients reported significant reduction of daily “off” time, and improvement in dyskinesia duration and disability. Physicians, patients and caregivers reported moderate-marked global improvement as rated by the CGI-C. The procedure and treatment were generally well tolerated despite transient procedure and device-related adverse events occurring in 6 patients. Conclusion: The initial experience with LCIG in our center has been positive as both the procedure and treatment proved to be safe and very beneficial for the motor features and global well-being of advanced PD patients.