%0 Journal Article
%T 24-hour levodopa-carbidopa intestinal gel may reduce troublesome dyskinesia in advanced Parkinson¡¯s disease
%J -
%D 2018
%R https://doi.org/10.1038/s41531-018-0070-4
%X Levodopa-carbidopa intestinal gel (LCIG) is effective for the control of motor fluctuations in Parkinson¡¯s disease (PD). The objective of this study is to report the reduction of dyskinesias after transitioning from 16 to 24-h/day LCIG infusion. From a cohort of 74 PD patients treated with LCIG for motor fluctuations, we identified 12 patients that were treated with 24-h per day infusion with the aim to control troublesome daytime dyskinesia. Clinical, demographic, dyskinesia rating scales were evaluated. Daytime dyskinesia was reduced in 75% (9/12) patients following treatment with 24-h therapy, including 7 who were compared with 16-h therapy and 2 that were transitioned from oral dopaminergic therapy to 24-h LCIG. Combining the data from all 12 subjects, troublesome dyskinesias were reduced during 24-h LCIG; UPDRS 4.1 (time spent with dyskinesias) mean change was £¿1.5£¿¡À£¿0.75, p£¿=£¿0.010 (Wilcoxon signed-rank test) and UPDRS 4.2 (functional impact of dyskinesias) mean change was £¿1.7£¿¡À£¿0.90, p£¿=£¿0.016, without changing their UPDRS part 3 ¡°ON¡± scores (p£¿=£¿0.138) or H&Y (p£¿=£¿0.157). In 5 patients, improvement in dyskinesia occurred despite an overall increase in the total daily levodopa dose. None of the patients had worsening of dyskinesia after a median follow-up of 28 months. 24-h per day infusion of LCIG may be a useful strategy in the management of troublesome dyskinesias in PD patients with disabling dyskinesias resistant to attempts to optimise 16-hours per day therapy. We postulate that this may be due to a pharmacodynamic as opposed to pharmacokinetic mechanism
%U https://www.nature.com/articles/s41531-018-0070-4