Efficacy of liquid sinemet in the management of non-motor symptoms in Parkinson’s disease

Ms Mary Danoudis1,2,3, Prof Robert Iansek1,2,3, Dr Chee Boon Sung1,3

1Monash Health, Cheltenham, Australia, 2Faculty of Medicine, Nursing and Health Sciences, School of Clinical Sciences, Monash University, Clayton , Australia, 3Parkinson Foundation, New York, USA



Efficacy of liquid sinemet in the management of non-motor symptoms in Parkinson’s disease


To investigate the effect of liquid sinemet on the non-motor symptoms of people with advanced Parkinson’ disease (PD) who experience motor fluctuations.

Advanced disease sees a decline in the response to oral PD medications, resulting in motor fluctuations. Motor fluctuations are also associated with fluctuating non-motor symptoms that may lead to a loss of independence and a decline in quality of life. Levodopa in solution (levodopa/carbidopa/ascorbic acid solution or LCAS) is effective at minimising fluctuations however the effect on non-motor symptoms has not been reported.


This study included sixteen participants with complex motor fluctuations that could not be managed with tablet formulations of levodopa. The main outcome was the change in the Non-Motor Symptoms Questionnaire (NMSQuest) score from baseline, when participants were taking their usual PD tablet formulations, to completion of LCAS dose titration. Secondary outcomes included Unified Parkinson’s Disease Rating Scale Part 1 Non-motor experiences of daily living, depression and quality of life.


Five participants prematurely discontinued LCAS. The remaining 11 participants showed a significant improvement in NMSQuest scores (p = 0.04), non-motor experiences of daily living (p = 0.04), depression (p = 0.01) and quality of life (p = 0.001).


This study provides evidence for the short term effectiveness of LCAS in the management of non-motor symptoms in PD. Liquid sinemet is a low cost, non-invasive and easily administered formulation of levodopa that can be micro-adjusted to provide maximum benefit.


Mary Danoudis has a Masters of Physiotherapy and works as a senior clinical physiotherapist for the Movement Disorders Program at the Kingston Centre Monash Health. Ms Danoudis works as a research physiotherapist in the Clinical Research Centre for Movement Disorders and Gait at Kingston Centre where she leads several studies on Parkinson’s disease. She has coordinated 2 large RCTs that investigated the effects of exercise on falls and mobility in Parkinson’s disease. She recently established a community based gym program for people with Parkinson’s disease that she is now evaluating.  Mary is committed to translating research findings into clinical practice.