Advanced Parkinson's therapy · London
Apomorphine, Duodopa, Produodopa or DBS, by a specialist nurse-led team.
When oral levodopa is no longer holding you steady, device-aided therapy can restore hours of good on-time. We compare all four options honestly against your motor diary and cognitive profile, in the London centres that run these programmes weekly.
Why patients choose us
- 01
An advanced therapy nurse, not just a neurologist
Device-aided therapy is a nurse-led programme. We match you to a specialist Parkinson's nurse who runs pump initiations weekly, not once a quarter.
- 02
All four options on the table
Apomorphine, LCIG (Duodopa or Lecigon), Produodopa, or DBS. We compare them honestly against your motor diary and cognitive profile, before you commit.
- 03
Independent, and free
We are paid by no clinic, so the recommendation is impartial and costs you nothing.
Indicative pricing
What advanced Parkinson's therapy costs privately.
Indicative ranges across our partner units. Send the current medication list and motor diary and we quote firm figures across two or three options.
In short
Pump therapy in London: £8,500 to £45,000 a year, DBS one-off £65,000 to £95,000.
| Therapy | Indicative range | Regimen | Setup |
|---|---|---|---|
| Advanced therapy assessment (nurse + neurologist + MoCA) | £1,400 to £2,200 | 2 to 3 hours | 2 to 3 weeks |
| Apomorphine (Dacepton / APO-go) drug + pump + sets, per year | £8,500 to £14,000 | 12 to 16 h/day | Setup £3,500 |
| Duodopa or Lecigon LCIG, all-in per year | £22,000 to £38,000 | 16 h/day | PEG-J day case |
| Foslevodopa/foscarbidopa (Produodopa), all-in per year | £28,000 to £45,000 | 24 h continuous | Nurse-led setup |
| Deep brain stimulation, one-off surgery + programming | £65,000 to £95,000 | 6 to 8 h theatre | 12 week titration |
| Second-opinion review of a current pump regimen | £450 to £750 | 60 min | 48 hours |
Prices vary by centre and by which pump platform is chosen. Many insurers fund advanced therapy when NICE criteria are met. We confirm cover and quote firm figures within one working day.
The journey
From assessment to long-term follow-up, what happens, in order.
One nurse-led team from first message to annual MDT - including the pump initiation and the palliative planning that comes later.
- 01
Assessment
You send us the referral and current medication list
A short, confidential form. Levodopa dose and frequency, off-period hours per day, dyskinesia severity, MoCA score if known, and any impulse control history.
- 02
Assessment
We come back with a recommendation
Within two working days: which of the four device-aided therapies fits, or whether oral optimisation still has room. Indicative all-in cost. An honest read either way.
- 03
Assessment
Assessment clinic and motor diary
A 3-day motor diary, MoCA cognitive screen, mood assessment, and orthostatic blood pressure. The advanced therapy nurse reviews before the neurologist consultation.
- 04
Setup
Apomorphine challenge or PEG-J placement
Apomorphine: a supervised subcut challenge with domperidone cover. LCIG: nasojejunal trial first, then PEG-J under sedation. Produodopa: a nurse-led subcut initiation over 1 to 2 days.
- 05
Setup
Dose titration in the unit
Titration takes 2 to 5 days as an inpatient or day-attender. The nurse rewrites your oral regimen around the pump and teaches you site rotation, alarms, and cleaning.
- 06
Long term
Home with 24/7 helpline
You go home with a working pump, a printed schedule, and a 24-hour nurse contact. First check-in at one week, then at 4 and 12 weeks.
- 07
Long term
Long-term follow-up and MDT
Quarterly nurse review, six-monthly neurologist review, annual MDT with palliative and neuropsych input. PEG-J tubes are reviewed at 12 months for planned replacement.
When to consider it
The 5-2-1 criterion, and the safety gates.
The triggers that make device therapy appropriate, plus the cognitive and psychiatric signs that mean one therapy is chosen over another.
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Off periods more than 2 hours per day
Predictable or unpredictable off time despite four or more doses of levodopa a day - the 5-2-1 criterion (5 doses, 2 h off, 1 h dyskinesia) is the standard trigger.
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Troublesome peak-dose dyskinesia
Involuntary movements that interfere with eating, dressing or social life, and cannot be tamed by fractionating the oral regimen.
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Sudden unpredictable off freezing
Sudden loss of mobility mid-task, without warning. Apomorphine pen rescue or continuous infusion often the fastest fix.
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Failed oral optimisation
A specialist has already tried COMT inhibitors (opicapone, entacapone), MAO-B inhibitors, extended-release levodopa, and amantadine.
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Nocturnal akinesia and early-morning off
Waking rigid and unable to turn in bed. Continuous 24 h infusion (Produodopa) or nocturnal apomorphine can restore sleep.
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Swallowing still safe, cognition intact
A MoCA above 21 to 24, no active hallucinations, and no untreated impulse control disorder - the core eligibility gate for all four therapies.
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Not suitable: moderate to severe dementia
A MoCA below 21, active psychosis, or severe orthostatic hypotension usually rules out DBS and apomorphine. LCIG may still be considered with a carer.
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Red flag: impulse control disorder
Pathological gambling, hypersexuality or compulsive shopping on dopamine agonists - apomorphine can worsen this. Discussed openly before you start.
Therapy options
Four device-aided therapies, compared honestly.
What each option actually involves in daily life - not just the drug, but the pump, the sites, the tubes and the appointments.
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Apomorphine subcutaneous (Dacepton, APO-go)
Intermittent pen for rescue, or continuous 12 to 16 h/day pump. Requires 3 days of domperidone cover to start. Side effects: skin nodules, nausea, sedation, impulse control.
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Duodopa / Lecigon LCIG via PEG-J
Levodopa-carbidopa intestinal gel infused directly into the jejunum via a PEG-J tube for 16 h/day. High practical burden but excellent for severe motor fluctuations. Jejunal tube revision is common in the first 12 months.
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Produodopa (foslevodopa/foscarbidopa)
A soluble prodrug of levodopa given as a 24-hour continuous subcutaneous infusion. Approved 2024. Less bulky than LCIG, no PEG required, but needs strict site rotation to avoid infusion-site reactions.
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Deep brain stimulation (STN or GPi)
Bilateral electrodes into the subthalamic nucleus or globus pallidus, connected to an implanted pulse generator. One-off surgery, 12-week programming schedule. Best for younger patients with troublesome dyskinesia and intact cognition.
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Continued oral optimisation
Sometimes the honest answer is not a device. Adding opicapone, switching to a rotigotine patch, or adjusting dose intervals can add 12 to 24 months before device therapy becomes essential.
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Focused ultrasound (unilateral)
MR-guided focused ultrasound thalamotomy or pallidotomy for tremor-dominant or dyskinesia-dominant disease, on one side. Incisionless, no hardware, but unilateral only.
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MDT palliative input
Advanced PD is a life-limiting condition. Early palliative involvement plans for the eventual withdrawal of device therapy and preserves quality of life throughout.
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Second-opinion pump review
A specialist review of your current pump regimen, motor diary and side-effect log - sometimes a rate change or a switch of therapy is the right answer, not a new device.
London advanced therapy centres
A small panel of specialist units, we picked them.
The five London services that run advanced Parkinson's therapy programmes with weekly nurse initiation lists and full MDT support.
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National Hospital for Neurology (UCLH Private)
Queen Square. All four therapies, DBS programme with the largest UK volume, complex-case MDT.
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King's College Hospital (Private wing)
PD Advanced Therapy Service, particular strength in LCIG and Produodopa initiation.
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HCA The Wellington Hospital
St John's Wood. Movement disorders team with apomorphine and Produodopa lists, private DBS pathway.
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Cleveland Clinic London
Grosvenor Place. Full neurology and neurosurgery service, DBS and LCIG.
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Imperial Private (Charing Cross)
West London. Apomorphine and LCIG initiation, focused ultrasound programme.
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Advanced therapy nurses with weekly pump initiation lists, not quarterly
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MDT access: neurology, neurosurgery, colorectal (for PEG), neuropsychology, palliative care
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Experience across all four therapies - apomorphine, LCIG, Produodopa and DBS
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24-hour helpline for pump alarms, blocked tubes and site reactions
Safety and monitoring
What to plan for - honestly.
Every device therapy has trade-offs. Site reactions, tube complications, neuropsychiatric changes and orthostatic hypotension are the four to plan for.
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Apomorphine: skin nodules and nausea
Firm subcutaneous nodules in 30 to 70% of pump users, usually manageable with site rotation and ultrasound. Nausea is prevented with 3 days of domperidone cover before starting.
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Apomorphine: impulse control disorder
Dopamine agonists including apomorphine can trigger pathological gambling, hypersexuality or compulsive shopping. Screened at baseline and quarterly.
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LCIG: jejunal tube complications
Tube kinking, blockage, dislodgement or accidental removal is common in year one. Around 60% of patients need at least one tube revision within 12 months.
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LCIG: peripheral neuropathy risk
Long-term LCIG can cause a subacute demyelinating neuropathy from B12 and B6 imbalance. Annual bloods and prophylactic B-vitamin supplementation are standard.
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Produodopa: infusion-site reactions
Redness, nodules or cellulitis at the subcutaneous site in around 60%. Strict daily site rotation and good aseptic technique reduce this considerably.
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DBS: surgical risks
Intracranial haemorrhage in 1 to 2%, infection in 3 to 5%, hardware complications in 5 to 10%. Speech, mood and cognition can be affected and are screened for pre-op.
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Neuropsychiatric monitoring
Hallucinations, apathy, depression and impulse control are tracked at every visit. Cognitive decline can develop after DBS in older patients - a key reason for MoCA screening.
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Orthostatic hypotension
All levodopa-based therapies can worsen postural drops. Blood pressure lying and standing is checked at every review, with midodrine or fludrocortisone added when needed.
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Red flags: call the helpline
Sudden pump alarm, tube dislodgement, severe site infection, new confusion, or a fall with head injury - call the 24-hour nurse line or attend A&E the same day.
Reading your assessment
Your assessment in four parts. Read the last one first.
Whichever therapy you consider, the assessment letter keeps to the same shape.
A quiet reminder
Neurology language is precise and can read coldly - we translate it for you.
If you would like us to talk you through the letter before your review, just ask.
- 01 Header
Diagnosis stage and 5-2-1 assessment
Confirmation of idiopathic PD, disease duration, current levodopa equivalent daily dose, off hours per day, and dyskinesia severity by UDysRS.
- 02 Assessment
MoCA, mood and impulse control screen
Cognitive score, HADS or GDS mood score, QUIP-RS impulse control questionnaire, and orthostatic blood pressure. These decide which of the four therapies is safe.
- 03 Findings
Recommended therapy and rationale
Which device is recommended and why, alternative options considered, and the specific reasons any therapy is not suitable for you.
- 04 Impression
Titration plan and long-term follow-up
Read this first: setup date, expected inpatient stay, first review dates, and the MDT members who will be involved long term.
Recognised by major UK insurers
Cover for advanced Parkinson's therapy varies by insurer - usually funded when NICE criteria are met. We confirm cover before booking.
Frequently asked
Everything we get asked about advanced Parkinson's therapy.
Quick answers on eligibility, costs, cognition and the London centres that offer these programmes.
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When should I consider advanced therapy for Parkinson's?
The standard trigger is the 5-2-1 criterion: taking 5 or more levodopa doses a day, having 2 or more hours of off time, or 1 or more hours of troublesome dyskinesia, despite properly optimised oral medication. If any of these apply, a formal advanced therapy assessment is appropriate. Waiting too long shrinks the benefit, particularly for DBS.
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What is the difference between apomorphine, Duodopa and Produodopa?
Apomorphine is a dopamine agonist given subcutaneously, either as a rescue pen or a 12 to 16 hour pump. Duodopa (or Lecigon) is levodopa gel infused into the jejunum via a PEG-J tube for 16 hours. Produodopa is a levodopa prodrug given as a 24-hour subcutaneous infusion. All three treat motor fluctuations, but the delivery, side-effect profile and daily burden differ substantially.
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How much do these therapies cost privately in the UK?
Apomorphine is £8,500 to £14,000 a year for drug and consumables, plus about £3,500 setup. LCIG (Duodopa or Lecigon) is £22,000 to £38,000 a year all-in, including PEG-J placement and nurse support. Produodopa is £28,000 to £45,000 a year. DBS is a one-off £65,000 to £95,000, including surgery, hardware and 12 weeks of programming. Many insurers cover advanced therapy when NICE criteria are met.
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Can I still access these therapies on the NHS?
Yes. All four are commissioned by NHS England through designated advanced therapy centres, and NICE TA guidance supports their use. A private assessment can shorten the waiting list, and some patients start privately and transfer to NHS supply once established. We help map the pathway either way.
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Which London centres offer advanced Parkinson's therapies privately?
The main private services are at the National Hospital for Neurology and Neurosurgery (UCLH Private) in Queen Square, King's College Hospital Parkinson's Advanced Therapy Service (private wing), HCA The Wellington Hospital movement disorders team, Cleveland Clinic London, and the Imperial Private service at Charing Cross. Each has slightly different strengths - we match you to the one that fits your therapy.
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Can I have advanced therapy if I have some memory problems?
It depends on severity. Mild cognitive impairment (MoCA above 21) is usually not a barrier to LCIG or apomorphine with a supportive carer. DBS generally requires a MoCA above 24 and a normal neuropsychological profile - cognition can worsen after surgery. Active dementia or hallucinations usually mean device therapy is not appropriate, and palliative-orientated care becomes the focus.
Talk to us
Ready to talk about device-aided therapy?
Send us the current medication list and a short note on your off-time and dyskinesia. We come back within one working day with a clear read on which of the four therapies fits and which London centre is right for you.
Related
Looking for something else?
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Deep brain stimulation
STN and GPi DBS for advanced Parkinson's.
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Movement disorders
Full private movement disorders service.
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Gastrostomy (PEG / RIG)
The PEG-J tube used for LCIG delivery.
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Parkinson's disease
Condition guide, from diagnosis to advanced stages.
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Focused ultrasound thalamotomy
Incisionless treatment for tremor and dyskinesia.
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Motor neurone MDT
Related neuromuscular MDT service.
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