ORIGINAL COMMUNICATION Long-term levodopa/carbidopa intestinal gel in advanced Parkinson’s disease Marı ´a T. Ca ´ceres-Redondo • Fa ´tima Carrillo • Marı ´a J. Lama • Ismael Huertas-Ferna ´ndez • Laura Vargas-Gonza ´lez • Manuel Carballo • Pablo Mir Received: 9 October 2013 / Revised: 23 December 2013 / Accepted: 23 December 2013 Ó Springer-Verlag Berlin Heidelberg 2014 Abstract The short-term benefits of levodopa/carbidopa intestinal gel (LCIG) in patients with advanced Parkinson’s disease (PD) are well documented, but the long-term ben- efits are still uncertain. The aim of this study was to investigate the motor and cognitive outcome of LCIG treatment in advanced PD after a follow-up period of at least 24 months. We assessed 29 patients with advanced PD who started LCIG infusion at our centre between 2007 and 2013. Motor fluctuations, parkinsonian symptoms, activities of daily living and impact on quality of life were evaluated. We also investigated the cognitive outcome using a battery of neuropsychological tests. All adverse events were recorded. Of the 29 PD patients who initiated LCIG, 16 patients reached the follow-up evaluation (24 months), after a mean time period of 32.2 ± 12.4 months. Six patients did not fulfil the 24-month follow-up visit and were evaluated after a mean time period of 8.6 ± 5.4 months. Seven patients discontinued the treatment before the scheduled visit. ‘‘Off’’ time and ‘‘On’’ dyskinesia duration were sig- nificantly reduced. LCIG improved quality of life and non motor symptoms, despite overall unchanged total levodopa doses prior to LCIG beginning. Motor and cognitive decline were detected. A relatively high number of adverse events occurred during the follow-up, above all, technical prob- lems with the infusion device and mild problems related with gastrostomy. There were four cases of peripheral neuropathy (PN), 2 of which were considered serious. Our data confirm that LCIG is beneficial in the long-term treatment of advanced PD patients despite a decline in cognitive functions in a subgroup of patients, probably due to disease progression. PN in patients with LCIG may be more frequent than the published date suggest. Keywords LCIG Á Advanced Parkinson’s disease Á Long-term Introduction Although levodopa remains the gold standard for the treatment of Parkinson’s disease (PD), long-term results are hampered by motor complications such as dyskinesias and fluctuations [1]. The mechanisms behind levodopa-associ- ated motor complications are not fully understood, but are hypothesised to be related to the inability of conventional levodopa regimens to provide physiologic, continuous dopaminergic stimulation. Levodopa is rapidly metabolised and has a short plasma half-life of approximately 90 min (when administered with carbidopa), thus requiring fre- quent, repeated dosing and producing fluctuations in drug plasma levels. It is absorbed mainly in the proximal small intestine, and gastric emptying plays an important role in determining the absorption of conventional oral levodopa formulations. Impaired gastric emptying is common in PD, and likely contributes to the unpredictable motor responses observed with orally-dosed levodopa [2]. Apomorphine pump therapy and subthalamic nucleus (STN) stimulation are effective for controlling motor M. T. Ca ´ceres-Redondo Á F. Carrillo Á M. J. Lama Á I. Huertas-Ferna ´ndez Á L. Vargas-Gonza ´lez Á M. Carballo Á P. Mir (&) Unidad de Trastornos del Movimiento, Servicio de Neurologı ´a y Neurofisiologı ´a Clı ´nica, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocı ´o/CSIC/Universidad de Sevilla, Av. Manuel Siurot s/n, 41013 Seville, Spain e-mail: pmir@us.es P. Mir Centro de Investigacio ´n Biome ´dica en Red sobre Enfermedades Neurodegenerativas CIBERNED, Madrid, Spain 123 J Neurol DOI 10.1007/s00415-013-7235-1