Can suitable candidates for levodopa/carbidopa intestinal gel therapy be identified using current evidence?

• Published in: eNeurologicalSci Vol. 8; pp. 44 - 53
• Main Authors: Catalán, Maria José, Antonini, Angelo, Calopa, Matilde, Băjenaru, Ovidiu, de Fábregues, Oriol, Mínguez-Castellanos, Adolfo, Odin, Per, García-Moreno, José Manuel, Pedersen, Stephen W., Pirtošek, Zvezdan, Kulisevsky, Jaime
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01-09-2017; Elsevier
• Subjects: Basic Medicine; Clinical Medicine; Duodopa; Intrajejunal infusion of levodopa/carbidopa intestinal gel; Klinisk medicin; Medical and Health Sciences; Medicin och hälsovetenskap; Medicinska och farmaceutiska grundvetenskaper; Motor symptoms; Neurologi; Neurology; Neurosciences; Neurovetenskaper; Non-motor symptoms; Parkinson's disease; Quality of life; Review; Duodopa; Parkinson's disease; Intrajejunal infusion of levodopa/carbidopa intestinal gel; Non-motor symptoms; ICD; QoL; Quality of life; PDSS; PEG; DBS; PD; APD; NMS; LCIG; NMSS; Motor symptoms; NMSS, Non-motor symptoms scale; DBS, Deep brain stimulation; PEG, Percutaneous endoscopic gastrostomy; PD, Parkinson's disease; APD, Advanced Parkinson's disease; LCIG, Levodopa-carbidopa intestinal gel; NMS, Non-motor symptoms; ICD, Impulse control disorders; PDSS, Parkinson's disease sleep scale; QoL, Quality of life
• ISSN: 2405-6502; 2405-6502
• DOI: 10.1016/j.ensci.2017.06.004

Advanced Parkinson's disease (APD) is characterized by increased functional disability, caused by motor complications, the presence of axial symptoms, and emergent disease- and drug-related non-motor symptoms. One of the advanced therapies available is intrajejunal infusion of levodopa/carbidopa intestinal gel (LCIG); however, patient selection for this treatment is sometimes difficult, particularly because of overlapping indications with other alternatives.
In recent years, strong evidence has supported the use of LCIG in treating motor fluctuations associated with APD, and several clinical studies provide emerging evidence for additional benefits of LCIG treatment in certain patients. This article provides an overview of the published literature on the benefits, limitations, and drawbacks of LCIG in relation to PD symptoms, the psychosocial impact of the disease, and the quality of life of patients, with the aim of determining candidates for whom treatment with LCIG would be beneficial. According to current evidence, patients with APD (defined as inability to achieve optimal control of the disease with conventional oral treatment), a relatively well-preserved cognitive-behavioral status, and good family/caregiver would count as suitable candidates for LCIG treatment. Contraindications in the opinion of the authors are severe dementia and active psychosis.