For more than 50 years, oral levodopa has been considered the gold standard in treatment for Parkinson’s Disease.

But there’s finally a breakthrough treatment that makes the drug even better, said Dr. Robert Wiggins, a neurologist with Novant Health Neurology & Sleep – Midtown in Charlotte. And Novant Health was among the first in the country to offer it. The name is Vyalev and in simple terms, it’s a form of liquid levodopa with a new delivery system that produces far better results.
Here, Wiggins explains what this leading-edge treatment means for Parkinson’s patients.
Holistic care for movement disorders
First, what exactly is Parkinson’s disease? And how common is it?
Parkinson’s disease is a chronic condition that leads to a not enough dopamine in the brain. It causes “movement issues” – slowness, tremors, rigidity, poor balance. Symptoms begin gradually – often on one side of the body – and progress over time. Between 500,000 and 1 million Americans have Parkinson’s.
What are the risk factors?
They include age – most people with Parkinson’s develop the disease after age 60. Only about 5% to 10% experience onset before 50. Other factors include family history and environmental exposure to pollution, pesticides, solvents, chemicals, heavy metals and more.
Tell me about levodopa.
It’s traditionally available in pill form, and it works really well. However, with time, it doesn't last that long, around 90 minutes. So, rather than taking it two or three times a day, which is where we typically start, patients sometimes have to take it five, six, seven times a day. If they don’t, the medicine wears off and their symptoms return.
And the new therapy lasts longer, I assume?
Yes, Vyalev is delivered right underneath the skin with a small patch you put on your abdomen. The patch connects to a pump and delivers levodopa all day and even overnight through that patch. Some patients forget they’re even wearing it. As we add to our local experience with this therapy, we will continue to learn more about how to help patients tolerate it well.
It’s remarkably innovative, because what we’ve had up until now is patients getting peaks and valleys of medication. And that can spell ups and downs for patients, too.
The goal of the new therapy is to have it be completely smooth and constant all day. The benefit of that comes from dopamine levels that remain pretty stable throughout the day.
When we eliminate the peaks and troughs, we can reduce the side effects patients feel – things like feeling slow, stiff or rigid, and something called dystonia – a painful neurological movement disorder that causes involuntary muscle contractions.
There’s also dyskinesia, or involuntary movements, which can be very bothersome. Michael J. Fox, who has bravely become the face of Parkinson’s, has dyskinesia. Retired NFL quarterback Brett Favre was also recently diagnosed with PD.
For years, we’ve been hoping for this therapy. It was just recently approved and found to be safe and effective.
Best doctors. Amazing nurses. Remarkable care.
How does it feel to be on the forefront of a new treatment?
We’re always trying to secure the best, newest therapies for patients. We want to offer the most leading-edge, safest, proven therapies. We want to be leaders in movement disorders – not only in Charlotte, not only in North Carolina, but in the Southeast and, in fact, in the country.
And we’re aggressive in that. We’re going to be part of a Phase IV trial for Vyalev. It’s already proven effective in research trials and been approved by the FDA. The Phase IV trial will look at how the medicine performs in “the real world” – outside a controlled environment – and what the benefits of this medicine are.
Who is the medicine right for?
It’s right for people who have Parkinson’s disease with motor fluctuations where oral levodopa is effective, but it wears off several times a day.
How does Vyalev work?
It does the exact same thing as levodopa; it is converted to dopamine, which is used in the brain to help people with Parkinson’s disease move more smoothly. What’s new is the delivery mechanism – the pump that’s delivering a steady flow of the medicine. The pump significantly reduces the medication valleys when people feel their Parkinson’s symptoms are back.
I have patients who don’t go out to eat with their spouse or friends because they don't know if their oral medicine will suddenly cut out, making it difficult to move well and continue with their social outing. Some tell me they can't exercise for the same reason – and exercise is one of the most important therapies for Parkinson’s.
Vyalev is continuous therapy for Parkinson’s. It’s a game changer.
Once a patient has been OK’d for this treatment, how often do they need to come in for titration or maintenance?
It's going to take probably two to three weeks to get them set on the exact right level of the medicine. But after that, the goal would be to see them just for maintenance appointments every six months or so.
Anything else you want to share?
Living with Parkinson's disease – and taking care of someone who has Parkinson's disease, for that matter – can be very challenging.
The purpose of this therapy is to restore quality of life and to try to help people have more joy and get back to doing the things they love. This advancement will, we hope, help people have more predictable days.