Profile of levodopa/carbidopa intestinal gel and its potential in the treatment of advanced Parkinson's disease

Sabine Skodda

Department of Neurology, Knappschaftskrankenhaus, Ruhr-University of Bochum, Bochum, Germany

Abstract: Parkinson's disease (PD) is characterized by a progression of symptoms in the course of time which typically leads to the occurrence of motor complications in the advanced stages of disease. In this stage of “motor complication”, conventional oral polypharmacotherapy often fails to preserve sufficiently stable motor function during the course of the day. Continuous infusions of levodopa/carbidopa gel (LCIG) delivered directly into the small intestine by a portable pump have been shown to stabilize levodopa plasma levels and to ameliorate motor fluctuations and troublesome dyskinesias in patients in the advanced stages of PD. Furthermore, there are also some first indications for beneficial effects on dopamine-related nonmotor symptoms of PD and an amelioration of overall quality of life. On the other hand, LCIG is an elaborate and expensive therapy, which requires the assured access to a medical team who are experienced with the management of adverse events and technical problems related to the tube and pump delivery system. This review focuses on the principle of LCIG infusion therapy and gives a comprehensive summary of the existing data on therapeutic effects and adverse events and possible complications.

Keywords: motor complications, continuous dopaminergic stimulation, dyskinesia, nonmotor symptoms, quality of life