CSFLI Reduces Motor and Non-Motor Symptoms in Advanced Parkinson’s Disease

Foslevodopa-Foscarbidopa Treatment Lowers Advanced Parkinson Disease Fluctuations

Continuous subcutaneous foslevodopa-foscarbidopa infusion alleviates motor complications and non-motor fluctuations in advanced Parkinson disease, according to a study published on October 26, 2026, in the European Journal of Neurology. Researchers observed the treatment effects over a three-month period among patients transitioning from oral levodopa therapy.

Key Clinical Takeaways:

• Continuous subcutaneous foslevodopa-foscarbidopa infusion significantly reduced OFF time, ON time with dyskinesias, and disabling dyskinesias over three months.
• Non-motor fluctuations during OFF periods decreased significantly, whereas ON-state non-motor fluctuations remained unchanged.
• Improvements appeared across multiple non-motor domains, including sleep, fatigue, mood, cognition, gastrointestinal, and urinary symptoms.

Study Methodology and Patient Demographics

The prospective, single-centre, real-world study evaluated 40 patients with advanced Parkinson disease who initiated continuous subcutaneous foslevodopa-foscarbidopa infusion between 2024 and 2026. Participants had a mean age of 67.05 years, with men comprising 80% of the cohort. The mean disease duration among the participants stood at 12.03 months.

Rosa De Micco and colleagues at the Department of Advanced Medical and Surgical Sciences at the University of Campania “Luigi Vanvitelli” in Naples, Italy, led the research. Investigators utilized standardised scales to assess motor complications, motor severity in both OFF and ON states, and non-motor symptoms. A dedicated standardised questionnaire measured non-motor fluctuations.

Symptom Reductions and Domain Improvements

Following three months of therapy, the analysis revealed significant reductions in motor complications, showing an FDR-adjusted P value of .001 across OFF time, ON time with dyskinesias, and disabling dyskinesias. Overall non-motor symptom burden also dropped significantly. Favourable changes occurred in the sleep or fatigue, mood or cognition, gastrointestinal, urinary, and miscellaneous domains, each recording an FDR-adjusted P value of .001.

Non-motor fluctuations during OFF periods showed notable decreases, with improvements registered in depression or anxiety, sleep or fatigue, and miscellaneous domains. Sleep-related symptoms, nocturnal and morning akinesia, depressive symptoms, and overall quality of life demonstrated significant reductions or favourable changes with an FDR-adjusted P value under .05. Conversely, daytime sleepiness, anxiety, fatigue, apathy, autonomic symptoms, and impulsive-compulsive behaviours registered no significant changes.

Clinical Implications and Study Limitations

Study authors noted that the findings provide preliminary evidence that continuous subcutaneous foslevodopa-foscarbidopa infusion may associate with improvements in non-motor fluctuations, particularly during the OFF state. They also highlighted the heterogeneous response of individual non-motor domains alongside the importance of treatment tolerability and persistence.

The observational design, small sample size, and absence of a control group prevented researchers from drawing causal inferences. The short follow-up period precluded an assessment of whether the observed effects persist over the long term. Clinicians adjusted treatments based on individual clinical judgment. Two authors declared receiving honoraria as speakers or consultants for multiple pharmaceutical companies, while the study received no specific funding.

Disclaimer: The information provided in this article is for educational and scientific communication purposes only and does not constitute medical advice.