A 74-year-old woman with advanced Parkinson’s disease (Hoehn & Yahr stage V) regained the ability to swallow solid food and walk with a walker after receiving a continuous subcutaneous infusion of foslevodopa/foscarbidopa. This treatment, reported by Cureus, successfully stabilized life-threatening non-motor symptoms, including severe hypoxia and hypertension, which had previously rendered the patient bedridden and dependent on tube feeding.
The case highlights a critical frontier in neurology: managing “secondary DBS failure,” where deep brain stimulation (DBS) no longer sufficiently controls motor fluctuations as the disease progresses. While DBS is a standard surgical intervention for Parkinson’s, this patient’s condition had deteriorated to a point where traditional oral medications and surgical adjustments could no longer maintain stable dopamine levels. The transition to a 24-hour continuous subcutaneous infusion of the foslevodopa/foscarbidopa (LDp/CDp) prodrug provided the steady state of dopamine necessary to restore basic physiological functions.
How Continuous Subcutaneous Infusion Restores Vital Functions
Before the intervention, the patient experienced “off” periods—intervals where medication wears off and symptoms return—that were not merely motoric but life-threatening. According to Cureus, these episodes included systolic hypertension reaching 200 mmHg and severe hypoxia (blood oxygen levels falling below 40%) caused by breath-holding spells. Because the patient suffered from severe dysphagia (difficulty swallowing), she required a percutaneous endoscopic gastrostomy (PEG) tube for all nutrition.
The clinical team bypassed the standard requirement for a preliminary levodopa challenge test to minimize the physical burden on the patient. They initiated LDp/CDp at a rate of 0.15 mL/hr. While the patient initially experienced transient auditory hallucinations—a known potential side effect of dopaminergic therapy—the dosage was titrated to 0.17 mL/hr. This adjustment ultimately increased her total daily levodopa equivalent dose (LED) from 1,025 mg to 1,208 mg.
The physiological impact was immediate. The respiratory dysfunction and cyanosis (bluish skin discoloration from lack of oxygen) resolved upon initiation. Most significantly, the patient’s swallowing function improved to the point that she transitioned from a liquid-only diet to minced textures, and eventually to chewing and swallowing solid food. This functional recovery also extended to mobility, allowing for walker-assisted gait during rehabilitation.
Continuous Pumps Provide Steady Medication and Stabilize Vital Functions
- Steady Medication Delivery: Instead of pills that cause “peaks and valleys” in drug levels, a continuous pump provides a constant stream of medicine through the skin, preventing dangerous “off” periods.
- Beyond Movement: This therapy can fix more than just tremors; it can stabilize breathing, blood pressure, and the ability to swallow.
- A Safety Net for DBS: For patients who have already had brain surgery (DBS) but find their symptoms worsening, this infusion can serve as a vital secondary treatment.
Broader Clinical Data Shows Effectiveness Requires Intensive Management
While the Cureus report focuses on a single, extreme case of recovery, a quality improvement report published by ScienceDirect provides a broader view of how this therapy performs in a larger cohort. The ScienceDirect data, based on 50 consecutive patients at a U.S. center between January 2025 and April 2026, suggests that while the therapy is highly effective for many, it requires intensive clinical management.
The ScienceDirect report noted that 82% of patients remained on the therapy at a median follow-up of 7.2 months. However, clinicians must manage specific practical limitations, most notably skin reactions, which occurred in 46% of the cohort. This contrast between the individual success in the Cureus case and the broader implementation challenges in the ScienceDirect study underscores the need for personalized titration.
| Metric/Observation | Single Case (Cureus) | U.S. Center Cohort (ScienceDirect) |
|---|---|---|
| Primary Goal | Restore swallowing & mobility | Stabilize motor fluctuations |
| Patient Severity | Hoehn & Yahr Stage V (Severe) | Median Age 68; Mixed Stages |
| Key Outcome | Resumption of oral intake | 78% improved motor fluctuations |
| Common Limitation | Auditory hallucinations | Skin reactions (46%) |
The mechanism of action for foslevodopa/foscarbidopa involves the continuous delivery of a prodrug—a substance that is converted into an active drug within the body. This bypasses the gastrointestinal tract, which is often unreliable in advanced Parkinson’s due to gastroparesis (slowed stomach emptying), and provides more predictable pharmacokinetics (how the body processes the drug) than oral tablets.
Regulatory Access and Clinical Management
The availability of such device-aided therapies (DAT) is increasingly dependent on regional healthcare frameworks. In the United States, the FDA oversees the approval of such infusion systems, while in Europe, the EMA manages regulatory pathways. For patients with advanced Parkinson’s, access to these technologies often hinges on the “5-2-1” criterion, a practical indicator used by clinicians to decide when to move from oral medication to device-aided therapy.
The implementation of LDp/CDp is not instantaneous. As noted by ScienceDirect, patients required a median of four clinical visits over 81 days to reach a stable, optimized dose. This highlights the intensive resource requirement for healthcare systems to support patients transitioning to continuous subcutaneous infusion.
Psychiatric, Skin, and Cognitive Risks Limit Therapy Suitability
Continuous subcutaneous infusion is a highly specialized therapy and is not suitable for all patients. Potential contraindications and risks include:
- Psychiatric Sensitivities: As seen in the Cureus report, rapid increases in dopamine levels can trigger auditory hallucinations or other psychiatric manifestations.
- Dermatological Issues: A significant portion of patients (46% according to ScienceDirect) may experience skin reactions at the infusion site.
- Severe Cognitive Impairment: The ability to manage the device or respond to titration changes is critical.
Consult a medical professional immediately if a patient on dopaminergic therapy experiences sudden confusion, hallucinations, severe skin irritation at the pump site, or unexpected changes in blood pressure.**
For the patient in this report, two years of follow-up confirmed that the improved quality of life was not a temporary spike, but a sustained clinical achievement.
References
- Mizuma A, et al. Cureus. A Case Report: Long-Term Subcutaneous Foslevodopa/Foscarbidopa Infusion Restores Ambulation and Oral Intake in Advanced Parkinson’s Disease After Deep Brain Stimulation.
- Anis S, Shaffer S. ScienceDirect. A clinical workflow from 50 consecutive patients at a single U.S. center: Continuous subcutaneous foslevodopa/foscarbidopa in advanced Parkinson’s disease.
