What to Know About Infusion Therapies in Parkinson’s Disease

Infusion therapies—especially subcutaneous treatments—are emerging as powerful tools for managing advanced Parkinson’s disease symptoms. One of the newest options, foslevodopa/foscarbidopa, offers a way to continuously deliver levodopa and carbidopa through a small, wearable pump. This allows for 24-hour symptom control, helping address both daytime motor fluctuations and challenging early morning "OFF" periods, when people may wake up with stiffness, pain, or depression. Unlike older options like Duopa (intestinal infusion), this method is minimally invasive and does not require surgery. The dosing can be adjusted for different times of day—for example, higher during the day and lower at night—to better match the brain's natural rhythm. Why Sleep Matters—and How Infusions Can Help Sleep issues are common but often overlooked in Parkinson’s. Research suggests that round-the-clock levodopa infusion can help reduce sleep fragmentation, potentially improving overall sleep quality. Better sleep may also support brain health and quality of life for both people with Parkinson’s and their caregivers. Infusion vs. Deep Brain Stimulation (DBS): Making the Right Choice Both DBS and infusion therapies can be effective, but the choice depends on several factors: Under age 70: DBS may be considered first, especially if tremors or severe dyskinesia are the main issues. However, patients should also be given the option to try subcutaneous infusion. Over age 70: Infusion therapy, especially foslevodopa/foscarbidopa, is often preferred due to its non-surgical nature and fewer side effects compared to dopamine agonists like apomorphine. Some may benefit more from apomorphine if they are struggling with apathy or depression, as it can lift mood in certain cases. Possible Side Effects and How to Manage Them Like all treatments, infusion therapies can come with side effects: Skin irritation: Redness or mild inflammation may occur around the infusion site. Rarely, this can progress to more serious conditions like cellulitis. Proper hygiene and site rotation are key to prevention. Neuropsychiatric symptoms: Overnight infusions might, in rare cases, contribute to hallucinations or confusion. Adjusting the nighttime dose—or temporarily pausing the infusion—can often resolve this. With careful monitoring and support, these side effects can typically be managed effectively. Final Thoughts Subcutaneous infusion therapies represent a significant advance in Parkinson’s care, offering personalized, flexible treatment that can improve motor and non-motor symptoms, sleep quality, and overall quality of life. As with any advanced therapy, it’s important that patients and care teams weigh the options together, taking into account individual needs, age, and preferences.