Among patients with Parkinson's disease (PD), long-term, oral levodopa therapy is often associated with motor fluctuations, resulting from alterations in the plasma concentration of levadopa. To overcome these fluctuations, various therapeutic modalities have been developed. With the exception of deep brain stimulation, these therapies have failed to demonstrate significant long-term safety and efficacy profiles among patients with advanced PD. This Middle Eastern study assessed the effect of levodopa-carbidopa intestinal gel (LCIG) monotherapy on patients with PD.

Subjects were 20 to 80 years of age, presenting with advanced PD with motor fluctuations and non-motor symptoms. All patients were hospitalized and underwent a nasoduodenal tube insertion with levodopa-carbidopa intestinal gel infusions. These infusions were divided into a morning bolus and a continuous hourly dose, with these based on the equivalent oral medications previously used. The on-time, off-time and LCIG doses were recorded. Outcome measures included the unified PD scale (UPDRS III), non-motor symptoms scale (NMSS) and PD questionnaire-8 (PDQ-8).

During follow-up, the mean off-time, UPDRS-III, NMSS and PDQ-8 score improvements were significantly better after the gel infusion therapy than before.

This study of patients with PD found that levodopa-carbidopa intestinal gel infusion monotherapy can significantly improve time-off, reduce levodopa-induced dyskinesia and improve nonmotor symptoms and quality of life among patients who are inadequately responding to traditional oral therapy.