Foslevodopa-foscarbidopa infusion

Advanced Parkinson's disease poses numerous management challenges related to an increasingly inconsistent and unpredictable response to oral levodopa therapy, complicated by disabling motor and non-motor fluctuations and dyskinesias. Deep brain stimulation, levodopa-carbidopa intestinal gel and subcutaneous apomorphine are established non-oral treatments for advanced Parkinson's disease but delivery of these therapies is restricted to small numbers in specialist centres. Continuous subcutaneous foslevodopa-foscarbidopa infusion (CSFFI) therapy may address this unmet need. Here, we provide experience and practical insights from delivering a CSFFI service within the UK National Health Service. We highlight advantages of CSFFI vs alternative device-aided treatment options and outline a framework for starting and maintaining treatment, including managing common side effects, illustrated by patient cases.