Abstract
Levodopa-carbidopa intestinal gel (LCIG) is one of the alternative treatment options for advanced Parkinson disease (PD) patients who experience motor fluctuations and insufficient control of their symptoms despite optimized combinations of oral medications. LCIG is continuously infused through a portable pump into the proximal small intestine, and has been proven to reduce “off” time as well as increase “on” time without significantly worsening troublesome dyskinesias. In addition, growing data also suggest improvement in some non-motor symptoms and the patient’s quality of life. The most common side effects of LCIG are procedural/device-related complications which can be frequent, especially within the first month of device placement, but generally mild and transient in nature. Interestingly, despite its clear efficacy and general safety and tolerability, it has not been utilized by providers to the same extent as other advanced therapies, such as deep brain stimulation surgery (DBS). In this review article, we discuss the evidence supporting LCIG’s efficacy, safety, adverse effects, tolerability, cost-effectiveness as well as potential contraindications. Furthermore, we also re-evaluate LCIG’s indications, utilization and potential limitations.