24-Hour infusion of levodopa/carbidopa intestinal gel for nocturnal akinesia in advanced Parkinson's disease

Levodopa/carbidopa intestinal gel (LCIG) is safe and efficacious in advanced Parkinson’s disease (PD).1,2 The infusion is approved for a maximum of 16 hours/day. The role of 24-hour administration is unclear, although its use has been reported.3 We evaluated 8 LCIG-treated patients who consented to receive round-the-clock LCIG infusion to address severe nocturnal akinesia, unresponsive to oral therapies. Patients provided informed consent. Patients were assessed before the initiation of LCIG infusion and at the last visit, 3 6 1.9 years later. At follow-up all patients had been on a 24-hour infusion regimen for 26 6 31.6 months (range, 4-72 months). Patients underwent evaluation for motor impairment (Unified Parkinson’s Disease Rating Scale [UPDRS-III]), disability (UPDRS-II), and complications (UPDRS-IV); axial impairment (Gait and Falls Questionnaire [GFQ]); nonmotor symptoms (Non-Motor Symptom Scale (NMSS); sleep quality (PD Sleep Scale [PDSS]); overall cognitive and neuropsychiatric function (UPDRS-I, Mini-Mental State Examination [MMSE], Neuropsychiatric Inventory [NPI], and the Questionnaire for Impulsive-Compulsive Disorders in PD [QUIP]); activities of daily living (ADLs), instrumental ADLs (IADLs), and healthrelated quality of life (8-item PD Questionnaire [PDQ-8]). The primary caregiver completed the Relative Stress Scale (RSS).4 The Wilcoxon paired test was used to compare baseline and follow-up assessments.