title: Levodopa/carbidopa intestinal gel (LCIG) infusion as mono- or combination therapy.
abstract: Levodopa/carbidopa intestinal gel (LCIG) infusion is an effective escalating therapy in patients with Parkinson disease (PD) suffering from motor fluctuations and dyskinesia. Levodopa/carbidopa given continuously as infusion provides an optimized application of the most effective and best tolerable antiparkinsonian drug. It has been proven to have a superior motor effect compared with oral levodopa and to improve also non-motor symptoms. However, invasiveness, discomfort resulting from carrying an external device, and side effects associated with the way of administration limit its application in PD patients. At present, there are no guidelines that delineate to which patients LCIG should be offered as monotherapy, in combination with oral and/or transdermal medication, or as additional therapy to deep brain stimulation (DBS). Based on clinical studies, we propose an expert consensus for neurologists addressing the question when LCIG therapy should be recommended and in which cases LCIG infusion is suggested in combination with other antiparkinsonian drugs and/or DBS. We describe how LCIG should be initiated and what we consider necessary for clinical follow-up. We suggest an algorithm facilitating decision-making with respect to the currently available invasive PD therapies, namely infusion with subcutaneous apomorphine, LCIG, and DBS.
authors.affiliation: Department of Neurology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany. buhmann@uke.uni-hamburg.de.
authors.forename: Carsten
authors.identifier: 0000-0001-8540-3789
authors.initials: C
authors.lastname: Buhmann
authors.affiliation: Department of Neurology, Klinikum Vest, Dorstener Strasse 151, 45657, Recklinghausen, Germany.
authors.forename: R
authors.initials: R
authors.lastname: Hilker
authors.affiliation: Department of Neurology, University Medicine Göttingen, Robert-Koch-Strasse 40, 37075, Göttingen, Germany.
authors.forename: P
authors.initials: P
authors.lastname: Lingor
authors.affiliation: Department of Neurology and Clinical Neurophysiology, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Schrader
authors.affiliation: Geriatric Hospital Haag, Krankenhausstrasse 4, 83527, Haag, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Schwarz
authors.affiliation: Department of Neurology, Elblandklinikum Meissen, Nassauweg 7, 01662, Meissen, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Wolz
authors.affiliation: Department of Neurology, University Hospital Dresden, Technische Universität Dresden, Fetscherstrasse 74, 01307, Dresden, Germany.
authors.forename: H
authors.initials: H
authors.lastname: Reichmann
mesh_terms: D000465:Algorithms; D000978:Antiparkinson Agents / Q000008:administration & dosage*; D002230:Carbidopa / Q000008:administration & dosage*; D003131:Combined Modality Therapy; D020000:Decision Support Systems, Clinical; D004338:Drug Combinations; D004359:Drug Therapy, Combination; D006801:Humans; D007260:Infusion Pumps; D007980:Levodopa / Q000008:administration & dosage*; D010300:Parkinson Disease / Q000188:drug therapy*
chemical_list: D000978:Antiparkinson Agents; D004338:Drug Combinations; C009265:carbidopa, levodopa drug combination; D007980:Levodopa; D002230:Carbidopa
keywords: Combination therapy; Levodopa/carbidopa infusion; Monotherapy; Parkinson disease