L-Dopa/Carbidopa intestinal gel infusion in advanced Parkinson's disease: real-life mobility insights from wearable sensors

Rationale/objectives: In advanced Parkinson's disease (APD), the intermittent dopaminergic delivery of oral L-Dopa contributes to the occurrence of fluctuations and dyskinesia. Continuous dopaminergic delivery through intrajejunal L-Dopa/Carbidopa intestinal gel (LCIG) is an established therapeutic strategy to manage these motor complications, but its impact on real-life motor performances has never been characterised objectively. This cross-sectional pilot study used wearable sensors to quantitatively evaluate the impact of LCIG on patients' motor performance in real-world settings. Material/methods: Forty-three APD patients, including 15 treated with LCIG infusion (APDLCIG) and 28 on the best oral dopaminergic therapy (APDL-Dopa), were evaluated using standardized clinical scales and sensor-based metrics. A validated waist-worn inertial wearable, positioned on the left side, continuously monitored spatiotemporal gait parameters (step length, stride speed, stride fluidity, and cadence) along with freezing of gait (FOG) occurrence, and time spent with dyskinesia. To quantify intra-day variability in motor performance associated with motor fluctuations, the coefficient of variation of all spatiotemporal gait parameters was calculated. Finally, clinical-behavioural correlations were analysed to examine possible relationships between gait features and clinical outcomes. Results: Despite comparable clinical and demographic profiles, APDLCIG showed less severe motor fluctuations than APDL-Dopa and exhibited lower intra-day variability in key spatiotemporal gait parameters (step length, stride speed, and stride fluidity). Dyskinesia duration was similar in APDLCIG and APDL-Dopa. Also, mean absolute values of gait parameters and FOG duration did not differ between groups. Stride fluidity, step length, and stride speed were moderately and inversely associated with age and disease severity. Discussion/conclusion: LCIG provides a more stable gait pattern than optimized oral dopaminergic therapy in appropriately selected APD patients, as captured by wearable sensors in real-world conditions. This likely reflects more consistent motor control throughout the day due to continuous dopaminergic delivery. By detecting fluctuation-related motor impairment through variability metrics, wearable sensor technology may offer a valuable tool to enhance the clinical management of LCIG, supporting patient selection, medication titration, and the longitudinal monitoring of treatment efficacy and safety.