Rescue Levodopa/Carbidopa Intestinal Gel for Secondary Deep Brain Stimulation Failure

Bautista, Juan Miguel Pilar; Oyama, Genko; Nuermaimaiti, Maierdanjiang; Sekimoto, Satoko; Sasaki, Fuyuko; Hatano, Taku; Nishioka, Kenya; Ito, Masanobu; Umemura, Atsushi; Ishibashi, Yuji; Shimo, Yasushi

doi:10.14802/jmd.19051

Cited by 6 publications

(15 citation statements)

References 12 publications

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“…Our study suggests that 2 DATs can exert a complementary beneficial effect on motor and non-motor fluctuations and QoL in selected PD patients and supports the findings of previous reports. [9][10][11][12][13][14] Because DBS and infusion therapies have different mechanisms of action, their combination is legitimate and provides an additive therapeutic effect. They also differ in invasiveness, safety profile, as well as nursing care requirements, 15,16 but only few comparative studies of these therapeutic options are available at the moment.…”

Section: Discussionmentioning

confidence: 99%

“…11,13 Axial symptoms, like freezing and postural instability, were the least responsive to dual therapy. 12 No change in levodopa equivalent daily dose was reported. 11,13 QoL with the DBS-LCIG combination was only explored in 4 of the 6 patients in a case series, highlighting a substantial improvement after the second therapy.…”

Section: Literature Reviewmentioning

confidence: 99%

“…We identified 6 articles, 4 case series, 9–12 1 retrospective, 13 and 1 prospective study 14 . They included a total of 50 patients in whom unilateral or bilateral DBS on various locations was always the initial choice.…”

Section: Literature Reviewmentioning

confidence: 99%

“…Motor outcomes were assessed in all cases, although in different ways. Most of them reported a substantial improvement in fluctuations and daily OFF time after implementing an infusion therapy in DBS‐treated patients 9–13 . Interestingly, re‐emergent dyskinesias responded adequately to the second therapy only in patients with a history of successful dyskinesias management with the initial DAT 10 .…”

Section: Literature Reviewmentioning

confidence: 99%

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Combining Device‐Aided Therapies in Parkinson's Disease: A Case Series and a Literature Review

Boura

Haliasos

Giannopoulou

et al. 2021

Movement Disord Clin Pract

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BackgroundBackground: Deep brain stimulation (DBS), levodopa-carbidopa intestinal gel (LCIG) and subcutaneous apomorphine infusion are device-aided therapies (DATs) for advanced Parkinson's disease (PD). We present a case series from the Cretan PD Registry who required 2 DATs for optimal management along with a systematic review of similar studies. Cases Cases: From 2009 to 2020, we retrospectively studied all PD patients who were simultaneously treated with 2 DATs. Six patients on DBS required an infusion treatment for persisting or re-emergent fluctuations because of disease progression. Two patients on LCIG infusion received DBS as a levodopa-sparing strategy because of drug-induced complications. Fluctuations and quality of life improved in all patients. Literature review Literature review: We identified 4 case series, 1 prospective and 1 retrospective study that included a total of 50 DBS-treated patients who required an infusion therapy. Improvement in motor outcomes, assessed in different ways, was a constant finding. Conclusions Conclusions: Selected PD patients on 1 DAT may experience additional benefit from a second DAT, for several reasons along the course of their disease. Although infusion therapies optimize dopaminergic drug delivery in fluctuating DBS-treated patients, DBS added on LCIG treatment has an additive symptomatic effect that allows levodopa dose reduction in patients with drug-induced side effects.Deep brain stimulation (DBS), levodopa-carbidopa intestinal gel (LCIG) and subcutaneous apomorphine infusion (SCAI) are device-aided therapeutic options (DATs) for intractable motor complications in advanced Parkinson's disease (PD). 1,2 Their longterm efficacy can be compromised by the recurrence of motor and non-motor fluctuations, as well as by the emergence of complications or non-responsive symptoms. [3][4][5][6][7] Studies addressing the combined effect of the above therapies are limited. We report a series of patients from the Cretan PD Registry who required 2 such therapies for the optimal management of their symptoms.Since 2009, all patients diagnosed with PD at the University Hospital of Heraklion in Crete (UHHC, a tertiary referral center for South East Greece) according to the United Kingdom (UK) PD Society Brain Bank Criteria are entered onto the Cretan PD Registry. This registry includes wellcharacterized PD patients, who are followed regularly along the course of their disease and was initially established with the aim of identifying the distinct phenotypic characteristics of familial PD in the isolated population of Crete. All advanced PD patients who were simultaneously on 2 active DATs from January 2009 to August 2020 were studied. Patients that switched from 1 therapy to another were not included. Indications for dual therapy, outcomes, and side-effects of these combinations are reported.

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Section: Discussionmentioning

confidence: 99%

Section: Literature Reviewmentioning

confidence: 99%

Section: Literature Reviewmentioning

confidence: 99%

Section: Literature Reviewmentioning

confidence: 99%

See 2 more Smart Citations

Combining Device‐Aided Therapies in Parkinson's Disease: A Case Series and a Literature Review

Boura

Haliasos

Giannopoulou

et al. 2021

Movement Disord Clin Pract

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show abstract

“…Recently, three DBS patients were reported in whom improvements in wearing-off occurred with the addition of LCIG, although only two patients with bilateral STN-DBS continued long-term treatment. 5 Elkouzi et al 4 proposed an algorithm for consideration of LCIG in those with persistent motor fluctuations post-DBS. Appropriate patient selection is particularly important when selecting patients for adjunctive medical therapy when DBS has failed to provide sufficient benefits despite reasonable improvement in motor UPDRS scores.…”

Section: Jmdmentioning

confidence: 99%

Parkinson’s Kinetigraph in the Selection of Levodopa-Carbidopa Intestinal Gel for Motor Fluctuations Refractory to Deep Brain Stimulation

Noui

Silverdale

Evans

et al. 2021

JMD

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Nationwide Retrospective Analysis of Combinations of Advanced Therapies in Patients With Parkinson Disease

Pürner,

Hormozi,

Weiß

et al. 2023

Neurology

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Rescue Levodopa/Carbidopa Intestinal Gel for Secondary Deep Brain Stimulation Failure

Cited by 6 publications

References 12 publications

Combining Device‐Aided Therapies in Parkinson's Disease: A Case Series and a Literature Review

Combining Device‐Aided Therapies in Parkinson's Disease: A Case Series and a Literature Review

Parkinson’s Kinetigraph in the Selection of Levodopa-Carbidopa Intestinal Gel for Motor Fluctuations Refractory to Deep Brain Stimulation

Nationwide Retrospective Analysis of Combinations of Advanced Therapies in Patients With Parkinson Disease

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