Koeglsperger Thomas, Berberovic Emir, Dresel Christian, Haferkamp Sebastian, Kassubek Jan, Müller Rahel, Oehlwein Christian, Paus Sebastian, Urban Peter Paul
Department of Neurology, LMU University Hospital, LMU Munich, Munich, Germany.
Department of Translational Brain Research, DZNE-German Center for Neurodegenerative Diseases, 81377, Munich, Germany.
J Neural Transm (Vienna). 2025 Mar 22. doi: 10.1007/s00702-025-02911-5.
Traditional advanced therapies in Parkinson's disease (PD) with motor fluctuations and dyskinesias like continuous apomorphine infusion (CSAI), levodopa-carbidopa intestinal gel (LCIG), levodopa-carbidopa entacapone intestinal gel (LECIG), or deep brain stimulation (DBS) have played a central role in managing therapy-related complications. Recently, continuous subcutaneous foslevodopa/foscarbidopa infusion (CSFLI) has emerged as a novel therapeutic option. This manuscript provides insights from one year of real-world experience with CSFLI, addressing critical questions that clinicians face when selecting the most appropriate therapy for advanced PD. Our discussion centers on key considerations for patient selection, exploring which individuals may benefit more from CSFLI compared to other device-aided therapies. We highlight CSFLI's advantages in flexibility and ease of use but also consider limitations, particularly its side effects, such as skin-related issues. Recommendations are presented on how to prevent and manage these adverse effects to maximize patient compliance and therapeutic success. Additionally, the paper examines strategies for optimizing concurrent oral medications when combined with CSFLI, providing guidance on balancing pump infusion with necessary adjunctive oral treatments.
帕金森病（PD）伴运动波动和异动症的传统先进疗法，如持续阿扑吗啡输注（CSAI）、左旋多巴-卡比多巴肠凝胶（LCIG）、左旋多巴-卡比多巴恩他卡朋肠凝胶（LECIG）或脑深部电刺激（DBS），在治疗相关并发症的管理中发挥了核心作用。最近，持续皮下注射左旋多巴/卡比多巴（CSFLI）已成为一种新的治疗选择。本文提供了CSFLI一年真实世界经验的见解，解决了临床医生在为晚期PD选择最合适治疗方法时面临的关键问题。我们的讨论集中在患者选择的关键考虑因素上，探讨哪些个体与其他器械辅助疗法相比可能从CSFLI中获益更多。我们强调了CSFLI在灵活性和易用性方面的优势，但也考虑到其局限性，特别是其副作用，如皮肤相关问题。文中给出了关于如何预防和管理这些不良反应以最大限度提高患者依从性和治疗成功率的建议。此外，本文还研究了与CSFLI联合使用时优化口服药物的策略，为平衡泵输注与必要的辅助口服治疗提供指导。
