Levodopa-Carbidopa Intestinal Gel (LCIG) in Deep Brain Stimulation (DBS) Parkinson’s Patients.

Congratulations to Drs. Ahmad El KouziLeonardo AlmeidaAdolfo Ramirez ZamoraPam ZeilmanMatthew BarabasIrene Malaty and Michael Okun on the publication of “Levodopa-Carbidopa Intestinal Gel (LCIG) in Deep Brain Stimulation (DBS) Parkinson’s Patients,” which was published in the April Supplement to Neurology.


Objective: To report experience of the use of LCIG in patients with advanced Parkinson’s disease (PD) previously treated with deep brain stimulation (DBS).

Background: DBS is an effective therapy for PD patients experiencing motor fluctuations. However, despite patients potentially achieving medication reduction, DBS does not replace scheduled dopaminergic therapy. LCIG is a recently FDA-approved therapy for advanced PD patients experiencing motor fluctuations. The combination of LCIG and DBS as a possible approach for severe motor fluctuations inadequately controlled by DBS alone in advanced PD has not been fully explored. In a recently published prospective small cohort of STN DBS patients, LCIG was shown to be an effective therapy for treating refractory symptoms to DBS (Regidor et al., 2017).

Design/Methods: Case series.

Results: We conducted a retrospective review of 5 patients with advanced PD treated with DBS at University of Florida who later received LCIG therapy to address recurrence of refractory motor fluctuations. All patients were male, 3 had young onset PD and 3 had tremor-predominant PD. 3 patients underwent bilateral STN, 1 patient had bilateral GPi and 1 patient had right GPi DBS. The main indications for DBS were tremor, rigidity and bradykinesia in 2 patients, early wearing off and dyskinesia/dystonia in 3 patients. Patients showed a sustained DBS response, however, disease progression led to recurrence of severe motor fluctuations and unpredictable responses to oral levodopa. Initiation of LCIG therapy provided marked symptomatic improvement. Individual patient data of case series will be presented.

Conclusions: Patients with advanced PD may experience recurrence of motor fluctuations despite optimization of medical and neuromodulatory therapy. LCIG therapy might have a role as an adjunct to DBS for management of motor symptoms. Further studies are needed to identify specific PD phenotypes or symptoms that are more likely to benefit from a combination of DBS and LCIG therapies.