Robert McMillan has been living with Parkinson’s disease since 2011. While he has managed his medications well, the on/off cycles have been challenging, and he is particularly conscious of dyskinesia (involuntary movements) while walking.

“It’s distracting, and it gets worse when I’m in stressful situations,” Robert explains. “I really want to present my daughter at her debutante ball, but I want all eyes to be on her, not me.”

Dr. Sanjay Iyer, who also has a daughter, understood Robert's concerns. Robert was an ideal candidate for Vyalev, a levodopa pump approved in October. With the ball approaching in November, the MMC team worked with AbbVie, the drug manufacturer, to expedite Robert’s initiation. On November 18th he became the fifth patient in the United States to receive the new pump.

“Levodopa is the mainstay of treatment for Parkinson’s, but the biggest problem is the way we dose it,” Dr. Iyer explains.  “When patients take an oral dose, if it’s a little too much, they may experience dyskinesia, and as it wears off, they can freeze up. Our brains naturally release dopamine all day in a very steady stream, and this pump recreates that consistent, around-the-clock release the way nature intended.”

Vyalev has been used in Europe for about two years, and the data is very promising.

“Studies so far have shown that by administering this medication through a continuous pump, we can reduce fluctuations in symptoms and give patients tight control 24 hours a day.  For Robert, that means he can present his daughter at the ball.”

Robert’s wife, Ashley, couldn’t be more proud. “We’ve been waiting and dreaming about this pump for years. He works so hard to manage his symptoms and stay positive, but it’s tiring. The kids have been great and they understand, but it means so much for him to walk with our daughter. We’re humbled, and he is ready for this.”

Robert credits his wife. “Ashley puts up with me even on the most challenging days. And I’m honored to be one of the first to use the pump! We’re going to learn more together, and if this contributes in a small way that will impact the larger Parkinson’s community, that’s certainly meaningful.”

How Does It Work?

Vyalev is a subcutaneous, 24-hour delivery system. Robert will carry a small electronic device, about the size of a large cell phone, in his pocket or a bag. The device contains a one-day dose of medication, connected to a thin, flexible tube that runs to a tiny cannula attached to the skin on his abdomen. Each day, he will refill the medication, change the battery, and reposition the cannula to avoid skin irritation. It may take a few days to find the correct dosage, and Dr. Iyer will program the pump and make small adjustments until symptoms are ideally managed.

The cannula is not painful, and because he will no longer swallow pills, his symptoms will not be affected by digestion or diet. “I plan to enjoy the ball without worry,” Robert smiles.