STN-DBS and LCIG differentially affect long-term axial symptoms in Parkinson’s disease

Bilateral subthalamic nucleus Deep Brain Stimulation (STN-DBS) and Levodopa-Carbidopa Intestinal Gel (LCIG) represent established treatment options for complicated Parkinson’s disease (PD). Evidence regarding their effectiveness on axial symptoms remains limited, despite disability. This observational real-world cohort study included 317 PD patients who received STN-DBS ( N = 203) or LCIG ( N = 114) between 2005 and 2023 at two Italian centeres to compare their short- and long-term effects on axial symptoms. At baseline, LCIG group exhibited more severe axial and motor symptoms and higher prevalence of cognitive abnormalities than STN-DBS cohort. Longitudinally, LCIG treatment was associated with lower odds of long-term axial deterioration compared with STN-DBS, after adjustment for baseline differences and levodopa equivalent daily dose, despite an increased risk of dyskinesias. A significant treatment-by-time interaction suggested more favourable long-term axial symptom trajectories in the LCIG group.