This summary provides key information on the implementation and clinical adoption of subcutaneous infusion systems for the management of advanced Parkinson's disease (PD). Continuous subcutaneous medication delivery represents an important therapeutic option for patients experiencing motor fluctuations and dyskinesias despite optimized oral therapy.

Clinical Indications

Advanced Parkinson's disease with motor fluctuations not adequately controlled by oral medications
Patients experiencing significant "off" periods or troublesome dyskinesias
Candidates who would benefit from continuous dopaminergic stimulation
Patients with preserved levodopa response but struggling with oral medication regimens

Available Medication Options

Apomorphine: Potent non-ergoline dopamine agonist delivered via subcutaneous infusion
Levodopa-carbidopa intestinal gel (LCIG): While technically not subcutaneous, provides an alternative continuous infusion approach
Foslevodopa/foscarbidopa suspension: Recently approved subcutaneous formulation of levodopa/carbidopa

Patient Selection Considerations

Preserved levodopa responsiveness
Adequate cognitive function to manage the device (or reliable caregiver support)
Absence of contraindications to specific medications (cardiac issues for apomorphine)
Patient/caregiver willingness and ability to maintain infusion system
Assessment of skin integrity for infusion site management

Implementation Steps

Patient assessment and selection: Comprehensive evaluation by movement disorder specialist
Medication trial: Initial test dose under medical supervision
Education and training: Patient and caregiver instruction on device operation and maintenance
Initiation of therapy: Typically begins in inpatient or closely supervised outpatient setting
Titration phase: Gradual adjustment of infusion rate to optimize symptom control
Regular follow-up: Monitoring for efficacy, side effects, and infusion site management

Clinical Benefits

Reduction in "off" time and dyskinesias
More consistent motor symptom control
Potential reduction in oral medication burden
Improved quality of life metrics
Enhanced ability to perform activities of daily living

Common Challenges and Management

Infusion site reactions: Proper site rotation and hygiene protocols
Technical difficulties: Troubleshooting device issues and proper maintenance
Medication side effects: Monitoring for nausea, orthostatic hypotension, impulse control disorders
Patient adherence: Regular reinforcement of proper technique and schedule