Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2021 Jun 12;11(6):547.
doi: 10.3390/jpm11060547.

Combined and Sequential Treatment with Deep Brain Stimulation and Continuous Intrajejunal Levodopa Infusion for Parkinson's Disease

Daniël van Poppelen  1 , Annelie N M Tromp  1 , Rob M A de Bie  1 , Joke M Dijk  1
Affiliations
Review

Combined and Sequential Treatment with Deep Brain Stimulation and Continuous Intrajejunal Levodopa Infusion for Parkinson's Disease

Daniël van Poppelen et al. J Pers Med. .

Abstract

(1) Background: Deep brain stimulation (DBS) and continuous intrajejunal levodopa infusion (CLI) are efficacious treatments of medication related motor response fluctuations in advanced Parkinson's disease (PD). Literature regarding the use of both advanced treatments within one patient is scarce. (2) Methods: We present a retrospective single center case series and a review of the literature. Patients with PD who were treated with both DBS and CLI in our tertiary referral center between 2005 and 2020 were identified and medical records were assessed. Additionally, literature on patients treated with both therapies was systematically searched for in Medline and Embase. (3) Results: Nineteen patients were included. Medication related motor response fluctuations were a major indication for the second therapy in all but one. Of nine patients initially treated with DBS, five reported improvement with CLI. Seven of ten patients initially treated with CLI experienced benefits from DBS. The systematic literature search resulted in fifteen previous publications comprising 66 patients. Of the 59 patients, for whom the effect of the second treatment was known, 57 improved. (4) Conclusions: PD patients, who have persisting medication related motor response fluctuations, despite DBS or CLI treatment, may benefit from an additional or alternative treatment with either CLI or DBS.

Keywords: Parkinson’s disease; deep brain stimulation; levodopa; levodopa/carbidopa enteral infusion.

PubMed Disclaimer

Conflict of interest statement

D.v.P. and A.N.M.T. report no financial disclosure. J.M.D. received funding for research from ZonMw (governmental funding organization) and an unrestricted research grant from Medtronic for a study comparing treatment with DBS and CLI in advanced Parkinson’s disease; further unrestricted funding received from “Stichting Parkinson Nederland” (PD research foundation) and Amsterdam Neuroscience. R.M.A.d.B. received funding for research from ZonMw (governmental funding organization), the Parkinson Vereniging (patient organization) and an unrestricted research grant form Lysosomal Therapeutics, GE Health, Medtronic, and NeuroDerm. These funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results.

Figures

Figure 1
Figure 1
Flow chart: Selection of Studies.
See this image and copyright information in PMC

References

    1. Deuschl G., Schade-Brittinger C., Krack P., Volkmann J., Schäfer H., Bötzel K., Daniels C., Deutschländer A., Dillmann U., Eisner W., et al. A randomized trial of deep-brain stimulation for Parkinson’s disease. N. Engl. J. Med. 2006;355:896–908. doi: 10.1056/NEJMoa060281. - DOI - PubMed
    1. Olanow C.W., Kieburtz K., Odin P., Espay A.J., Standaert D.G., Fernandez H.H., Vanagunas A., Othman A.A., Widnell K.L., Robieson W.Z., et al. Continuous intrajejunal infusion of levodopa-carbidopa intestinal gel for patients with advanced Parkinson’s disease: A randomised, controlled, double-blind, double-dummy study. Lancet Neurol. 2014;13:141–149. doi: 10.1016/S1474-4422(13)70293-X. - DOI - PMC - PubMed
    1. Worth P.F. When the going gets tough: How to select patients with Parkinson’s disease for advanced therapies. Pract. Neurol. 2013;13:140–152. doi: 10.1136/practneurol-2012-000463. - DOI - PubMed
    1. Volkmann J., Albanese A., Antonini A., Chaudhuri K.R., Clarke C.E., De Bie R.M.A., Deuschl G., Eggert K., Houeto J.L., Kulisevsky J., et al. Selecting deep brain stimulation or infusion therapies in advanced Parkinson’s disease: An evidence-based review. J. Neurol. 2013;260:2701–2714. doi: 10.1007/s00415-012-6798-6. - DOI - PMC - PubMed
    1. Dijk J.M., Espay A.J., Katzenschlager R., De Bie R.M.A. The Choice between Advanced Therapies for Parkinson’s Disease Patients: Why, What, and When? J. Parkinsons Dis. 2020;10(Suppl. S1):S65–S73. doi: 10.3233/JPD-202104. - DOI - PMC - PubMed