A longtime dream for many living with Parkinson’s disease has been to reduce the number of daily pills needed to manage symptoms. If your daily pill routine can fill up your hands, you probably relate. The more the disease progresses, the trickier it becomes to manage symptoms, and you end up needing more medications or more frequent doses, or both.
Pump-delivered therapy is a recent treatment approved by the U.S. Food and Drug Administration (FDA) in January 2015. It allows medication to be directly delivered as a gel into your small intestines. This method makes it possible to greatly reduce the number of pills needed and improve symptom relief.
Read on to learn more about how pump-delivered therapy works and how it might be the next big breakthrough in Parkinson’s treatment.
How pump-delivered therapy works
Pump delivery uses the same medication commonly prescribed in pill form, a combination of levodopa and carbidopa. The current FDA-approved version for pump delivery is a gel called Duopa.
Symptoms of Parkinson’s, like tremors, trouble moving, and stiffness, are caused by your brain not having enough dopamine, a chemical the brain normally has. Because your brain can’t be given more dopamine directly, levodopa works to add more dopamine through the brain’s natural process. Your brain converts levodopa to dopamine when it passes through.
Carbidopa is mixed with levodopa to stop your body from breaking down levodopa too soon. It also helps to prevent nausea, a side effect caused by levodopa.
To use this form of therapy, your doctor needs to perform a small surgical procedure: They will place a tube inside your body that reaches the part of your small intestines close to your stomach. The tube connects to a pouch on the outside of your body, which can be hidden under your shirt. A pump and small containers holding the gel medicine, called cassettes, go inside the pouch. Each cassette has 16 hours’ worth of gel that the pump delivers to your small intestines throughout the day.
The pump is then digitally programmed to release medication in the correct amounts. All you’ll have to do is change the cassette once or twice a day.
Once you have the pump, you’ll have to be monitored regularly by your doctor. You’ll also need to pay close attention to the area of your stomach where the tube connects. A trained professional will need to program the pump.
Effectiveness of pump-delivered therapy
The combination of levodopa and carbidopa is considered to be the most effective medication for Parkinson’s symptoms available today. Pump-delivered therapy, unlike pills, is able to provide a constant flow of medication. With pills, the medication takes time to get into your body, and then once it wears off you need to take another dose. In some people with more advanced Parkinson’s, the effect of the pills fluctuates, and it becomes harder to predict when and for how long they take effect.
Studies have shown that pump-delivered therapy is effective. It’s considered a good option for people in the later stages of Parkinson’s who may no longer be getting the same symptom relief from taking pills.
One reason for this is that as Parkinson’s progresses, it changes the way your stomach functions. Digestion can slow down and become unpredictable. This can affect how your medicine works when you’re taking pills, because the pills need to move through your digestive system. Delivering the medicine right to your small intestines lets it get into your body faster and consistently.
Keep in mind that even if the pump works well for you, it’s still possible you may need to take a pill in the evening.
Any surgical procedure has possible risks. For the pump, these can include:
- infection developing where the tube enters your body
- a blockage occurring in the tube
- the tube falling out
- a leak developing in the tube
In order to prevent infection and complications, some people may need a caretaker to monitor the tube.
Pump-delivered therapy still has some limits, as it’s relatively new. It may not be an ideal solution for all patients: A small surgical procedure to place a tube is involved, and the tube needs careful monitoring once in place. However, it does show promise in helping some people greatly lower their daily pill doses while giving them longer spans between symptoms.
The future of Parkinson’s treatment is still unwritten. As researchers learn more about Parkinson’s and how the disease works on the brain, their hope is to discover treatments that not only get rid of symptoms, but also help reverse the disease itself.