CSFLI Reduces OFF State Non-Motor Fluctuations in Advanced Parkinson’s

Continuous subcutaneous foslevodopa-foscarbidopa infusion (CSFLI) significantly reduced motor complications in patients with advanced Parkinson’s disease over a three-month period, according to research published October 26, 2026, in the European Journal of Neurology. The study, led by Rosa De Micco of the University of Campania "Luigi Vanvitelli" in Naples, Italy, tracked 40 patients as they transitioned from oral levodopa therapy to the infusion treatment.

Motor and Non-Motor Improvements

Patients experienced a notable decrease in motor complications, specifically reductions in OFF time, ON time with dyskinesias, and disabling dyskinesias. These findings reached statistical significance with a false discovery rate (FDR)-adjusted P-value of .001. Beyond motor control, the treatment was associated with a reduction in non-motor symptom burden. Favorable changes were documented in domains including sleep, fatigue, mood, cognition, and gastrointestinal and urinary function.

Non-motor fluctuations during the OFF state also showed significant improvement, particularly regarding symptoms related to sleep, fatigue, and mood. However, the study noted that non-motor fluctuations during the ON state remained unchanged throughout the three-month observation.

Small Sample Size Limits Causal Inferences

The research team utilized a prospective, single-center, real-world design to evaluate the transition to CSFLI. Participants had a mean disease duration of approximately 12 months, with a mean age of 67 years. While the results suggest potential benefits for symptom management, the study authors identified several limitations. The small sample size and the absence of a control group mean that causal inferences cannot be drawn from the data. Because the follow-up period was limited to three months, the long-term persistence of these clinical effects remains unknown.

Observed Clinical Outcomes

Clinical Considerations for Advanced Parkinson’s

When asked about the clinical implications of the findings, the researchers noted that the results provide preliminary evidence that CSFLI may address non-motor fluctuations, specifically those occurring during the OFF state. They emphasized the importance of treatment tolerability and the heterogeneous response of individual non-motor domains. Treatment adjustments were performed based on individual clinical judgment.