Advanced Parkinson’s Patients Show Improvement With Two New Treatments

August 18, 2016

People with advanced Parkinson’s disease have two new options to control their symptoms: Duopa, a carbidopa-levodopa gel infusion, and deep-brain stimulation.

Video: Dr. Duarte Macado on Medical Rounds (WFSB)


“Duopa is excellent for those with akinetic-rigid type Parkinson’s disease with at least 3 hours of ‘off’ time per day,” says Dr. Duarte Machado, a neurologist at the Chase Family Movement Disorders Center, “while deep-brain stimulation is excellent for those with significant tremor, troublesome dyskinesia, and other motor fluctuations.

Q.  What is Advanced Parkinson’s disease?

A.  Advanced Parkinson’s disease is considered in patients with Parkinson’s disease whose condition cannot be adequately further improved with medical therapy alone.  These patients experience motor fluctuations, which are alterations between periods of being “on,” during which the patient experiences a positive response to medication, and being “off,” during which the patient experiences a reemergence of the Parkinson symptoms suppressed during the “on” state.  There are several types of motor fluctuations, including “wearing off” phenomenon, unpredictable “off” periods, and freezing of gait.

Q.  For some patients experiencing persistent motor symptoms or side effects from oral medication, Duopa may be an option.

A.  Duopa, a carbidopa-levodopa gel infusion, is delivered as a continuous infusion (up to 16 hours a day) through a percutaneous gastrojejunostomy tube by battery powered pump, may be used in place of oral carbidopa-levodopa to decrease off time. Compared with intermittent dosing of immediate-release oral carbidopa-levodopa, continuous gel infusion of carbidopa-levodopa led to a significantly greater reduction in mean off-time (4.0 vs.  2.1 hours) and an improvement in mean on-time without troublesome dyskinesia (4.1 vs. 2.2 hours).

Q.  There is also another option that uses brain stimulation…how does this work?

A.  Deep brain stimulation (DBS) is currently the most frequently performed surgical procedure for the treatment of advanced PD.  In Parkinson’s disease, the cells of the subthalamic nucleus (STN) and globus pallidus pars interna (GPi), become abnormally activated.  Deep brain stimulation (DBS) consists of placement of an electrode lead in one of these brain structures.  High frequency DBS suppresses the excessive neuronal activity in these structures to restore normal function and is thus effective for improving Parkinson’s motor symptoms.

Q.  What type of patient would benefit from each procedure?

A.  Patients with Parkinson’s disease present in different ways, in that some have excessive muscle stiffness and slowness (akinetic-rigid type) while others have bothersome tremor (tremor predominant type).  Duopa is excellent for those with akinetic-rigid type PD with at least 3 hours of “off” time per day, while deep-brain stimulation is excellent for those with significant tremor, troublesome dyskinesia, and other motor fluctuations.