Journal of Movement Disorders

Letter to the editor

Optimizing Device-Aided Therapies in Advanced Parkinson’s Disease: A Case Series on Continuous Subcutaneous Apomorphine Infusion in Challenging Scenarios: Adrian Paul R De Leon, Roongroj Bhidayasiri, Onanong Phokaewvarangkul; Received February 25, 2025 Accepted May 12, 2025 Published online May 14, 2025; DOI: https://doi.org/10.14802/jmd.25045 [Accepted]

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Brief communication

Rescue Levodopa/Carbidopa Intestinal Gel for Secondary Deep Brain Stimulation Failure: Juan Miguel Pilar Bautista, Genko Oyama, Maierdanjiang Nuermaimaiti, Satoko Sekimoto, Fuyuko Sasaki, Taku Hatano, Kenya Nishioka, Masanobu Ito, Atsushi Umemura, Yuji Ishibashi, Yasushi Shimo, Nobutaka Hattori; J Mov Disord. 2020;13(1):57-61. Published online January 31, 2020; DOI: https://doi.org/10.14802/jmd.19051

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Objective
The long-term efficacy of deep brain stimulation (DBS) for motor fluctuations in advanced Parkinson’s disease (PD) has been well established; however, motor fluctuations may recur over time despite multiple adjustments of DBS settings and medications.
Methods
We conducted a retrospective chart review of three patients for whom levodopa-carbidopa intestinal gel (LCIG) was additionally administered as a rescue therapy for secondary DBS failure due to the recurrence of motor fluctuations.
Results
The three patients had advanced PD with a disease duration of 14–19 years, and had undergone DBS for motor fluctuations refractory to standard medical management. LCIG was administered to the patients because of symptom recurrence years after DBS and provided complementary effects in all patients.
Conclusion
The cases presented here show that rescue LCIG therapy may be a complementary treatment option for patients with post-DBS advanced PD who have a recurrence of troublesome motor complications.

Citations

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Invited Review

Apomorphine and Levodopa Infusion Therapies for Advanced Parkinson’s Disease: Angelo Antonini; J Mov Disord. 2009;2(1):4-9.; DOI: https://doi.org/10.14802/jmd.09002

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Abstract PDF

Continuous infusion of levodopa or apomorphine provide constant dopaminergic stimulations are good alternatives to deep brain stimulation to control motor fluctuations in patients with advanced Parkinson’s disease (PD). Apomorphine provides motor benefit similar to dopamine, but its long-term use is limited by compliance, mostly injection site skin reactions. Administration of levodopa/carbidopa by continuous duodenal infusion allows replacement of all oral medications and permits achievement of a satisfactory therapeutic response paralleled by a reduction in motor complication severity. However, this procedure is more invasive than apomorphine as it requires a percutaneous endoscopic gastrostomy Clinical experience with infusions shows that continuous dopaminergic stimulation of dopaminergic medications reduces dyskinesia and widens the therapeutic window in advanced PD.

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