Levodopa–carbidopa intrajejunal gel in advanced Parkinson disease with “on” freezing of gait

Freezing of gait is a common and disabling disorder in advanced Parkinson’s disease (PD). The relationship with dopaminergic medication is complex and often non-linear, thus freezing may occur even when the core parkinsonian features (tremor, rigidity and bradykinesia) appear optimally controlled. We evaluated the effect of Levodopa–carbidopa intrajejunal gel in a group of seven non-demented PD patients with prominent episodes of freezing refractory to adjustments of oral therapy. Clinical assessments were performed in the best “on” state before starting Levodopa–carbidopa intrajejunal gel, while patients were on their standard oral Levodopa (O-LD), and infusion treatment. The main outcome measures were change in freezing of gait (FOG) Questionnaire and UPDRS motor score. FOG Questionnaire and UPDRS subscores related to gait and postural stability significantly improved during Levodopa–carbidopa intrajejunal gel infusion in all patients compared to O-LD treatment. In four out of seven patients, the Levodopa–carbidopa intrajejunal gel dose was equivalent or slightly higher but in three patients was lower compared to O-LD dose recorded at baseline visit. In selected patients, Levodopa–carbidopa intrajejunal gel may improve freezing refractory to oral dopaminergic therapy.