034 Prospective study of 24-hour levodopa-carbidopa intestinal gel therapy for unresponsive freezing of gait

Abstract

IntroductionWe report a prospective, open-label study of 24-hour levodopa-carbidopa intestinal gel (LCIG) as treatment for levodopa ‘unresponsive’ freezing of gait (FOG) associated with Parkinson’s disease.Method14 patients with disabling FOG, documented as being levodopa ‘unresponsive’ following dose cycle assessment, were commenced on continuous 24-hour infusion LCIG therapy with the night-time rate at 50–80% of the daytime infusion rate. Patients underwent baseline and 6 months gait assessments, documentation of their falls frequency and completed FOG questionnaires. The statistical analysis was performed with SPSS 25 software (IBM), using Wilcoxon Signed Rank test and p < 0.05 was set as statistically significant.ResultThe fall frequency score reduced from 3 to 1 at 6 months (p=0.011), The FOG questionnaire was 19.3±1.5 at baseline and reduced to 16.0±1.7, at 6 months, respectively (p=0.039). The mean 360 degree turn time was not significantly changed (p=0.77). The daytime LCIG infusion rate was not significantly different before and after 24-hour LCIG therapy (p=0.315). 7 subjects developed visual hallucinations, one required temporary withdrawal from 24-hour LCIG, but as FOG worsened on 16-hour LCIG, he elected to recommence 24-hour LCIG infusion with improvement in FOG with a reduction in falls. 1 subject had postural hypotension which was ameliorated after adjustment of LCIG infusion rate.ConclusionWe provide further evidence that 24-hour LCIG therapy can reduce levodopa ‘unresponsive’ FOG and associated falls.