Continuous subcutaneous infusion therapy for advanced Parkinson's disease.

As Parkinson’s disease progresses, tablets taken several times a day may stop providing steady control of symptoms. Many people notice their medication wearing off before the next dose is due, unpredictable “off” periods where movement becomes difficult, or involuntary movements when medication levels peak. Increasing the dose or the frequency of tablets does not always solve this.

Continuous subcutaneous infusion therapy offers another approach. Rather than the peaks and troughs that come with tablets, medication is delivered steadily under the skin through a small, portable pump. A fine needle sits just beneath the skin, usually on the abdomen, and is repositioned regularly. The pump is worn discreetly and can be managed at home.

The aim is smoother, more predictable symptom control across the day, with less time spent “off” and fewer involuntary movements. For many people this means greater confidence in planning their day.

What is involved

  • Assessment of your current symptoms and medication regimen
  • Discussion of the available options, their benefits and their side effects
  • If you proceed, initiation with close supervision and dose adjustment
  • Training for you and your carer in using the pump and caring for the infusion site
  • Ongoing review to keep the therapy working well for you

 

Several infusion options are available, and suitability depends on each individual’s circumstances:
  • Apomorphine Infusion: A medication delivered continuously under the skin (subcutaneously) via a small pump. It can help reduce motor fluctuations in patients who experience significant “off” time despite oral treatment.
  • Levodopa-Carbidopa Intestinal Gel (Duodopa): A gel form of levodopa delivered directly into the small intestine through a tube. This provides steady levodopa levels and is suited to selected patients with more advanced symptoms.
  • Foslevodopa/Foscarbidopa (Vyalev): A newer 24-hour continuous subcutaneous infusion delivered through a wearable pump, offering a non-surgical option for managing motor fluctuations.
Infusion therapies are not suitable for everyone. Your neurologist will carefully assess whether one of these treatments may be appropriate for you, taking into account your symptoms, overall health, and response to current medications.

Parkinson’s disease is a complex and progressive neurological disorder that requires a comprehensive approach to management.

While there is currently no cure, advances in medical treatments, surgical options, and supportive therapies have significantly improved the outlook for individuals with Parkinson’s disease.

If you or a loved one are experiencing symptoms of Parkinson’s disease, it is important to seek medical advice from a neurologist who can provide a thorough evaluation, accurate diagnosis, and personalised treatment plan. With the right care and support, many people with Parkinson’s disease can continue to live meaningful and productive lives.

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