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PD – Levodopa Intestinal Gel — SCE Neurology MCQ

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ModerateMovement DisordersPD – Levodopa Intestinal GelSCE Neurology

A 68-year-old man with advanced Parkinson's disease has severe motor fluctuations and dyskinesia refractory to all oral medications. He is not suitable for deep brain stimulation due to cognitive impairment. What alternative device-aided therapy should be considered?

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Correct answer: E — Levodopa-carbidopa intestinal gel (LCIG/Duodopa) via percutaneous jejunostomy

LCIG (Duodopa) delivers levodopa continuously via a jejunal tube connected to a portable pump, providing stable plasma levels and reducing motor fluctuations. NICE NG71 recommends considering LCIG for patients with advanced PD and severe motor fluctuations not adequately controlled by oral therapy, particularly when DBS is contraindicated (e.g., significant cognitive impairment). A: Intrathecal baclofen is for spasticity. C: VNS is for epilepsy/depression. D: SCS is experimental for PD. E: Intrathecal morphine is for pain.

Reference: NICE NG71 Parkinson's Disease (2017)