Levodopa/carbidopa intestinal gel in treatment of non-motor symptoms in advanced Parkinson's disease

Abstract

To identify the advantages of LCIG in the treatment of NMS among APD patients and appraise the currently available literature to identify the gaps in the available evidence. background:Levodopa is the most commonly used drug for the treatment of motor symptoms of Parkinson's Disease (PD). For managing non-motor symptoms (NMS) in advanced Parkinson's disease (APD), levodopa-carbidopa intestinal gel (LCIG) infusion is preferred over oral levodopa-carbidopa because it bypasses the gastrointestinal tract and overcomes fluctuation and variation in the plasma drug levels. Levodopa is the most commonly used drug for the treatment of motor symptoms of Parkinson's Disease (PD). For managing non-motor symptoms (NMS) in advanced Parkinson's disease (APD), levodopa-carbidopa intestinal gel (LCIG) infusion is preferred over oral levodopa-carbidopa because it bypasses the gastrointestinal tract and overcomes fluctuation and variation in the plasma drug levels. LCIG has been found to be beneficial in improving or relieving various NMS. (central nervous system symptoms, cardiovascular system symptoms, gastrointestinal tract symptoms, systemic symptoms, urinary symptoms, reproductive system symptoms) in patients with APD. LCIG provides an uninterrupted intestinal levodopa infusion by percutaneous endoscopic gastrojejunostomy (PEG-J). It effectively decreases fluctuations in plasma concentrations of levodopa, reduces NMS burden and motor fluctuations in APD, however; adequate dose modification and individualization of therapy are essential for optimal effect.