New developments in continuous jejunal infusion of levodopa/carbidopa in advanced Parkinson’s disease

Levodopa-associated motor fluctuations and dyskinesia in patients with Parkinson's disease (PD) are often difficult to control by the oral administration of levodopa. Continuous infusion of a levodopa/carbidopa intestinal gel (LCIG) may represent a feasible treatment option for this patient population. To start LCIG infusion, a temporary nasoduodenal/nasojejunal tube should be considered to show that the patient responds favorably, before a permanent percutaneous endoscopic gastrostomy with jejunal tube (PEG-J) is placed. The present review focuses on recently published key studies on the efficacy and safety of LCIG treatment in advanced PD. The results provide robust evidence of a marked reduction of OFF-fluctuations and dyskinesia, thereby also improving the quality of life of these severely disabled patients. LCIG treatment is therefore a promising alternative to continuous subcutaneous apomorphine infusion or deep brain stimulation in advanced PD patients with severe motor fluctuations.