Collective physician perspectives on non-oral medication approaches for the management of clinically relevant unresolved issues in Parkinson's disease: Consensus from an international survey and discussion program

Odin, P. et al. (2015) Collective physician perspectives on non-oral medication approaches for the management of clinically relevant unresolved issues in Parkinson's disease: Consensus from an international survey and discussion program. Parkinsonism and Related Disorders, 21(10), pp. 1133-1144. (doi: 10.1016/j.parkreldis.2015.07.020) (PMID:26233582)

[img]
Preview
Text
191382.pdf - Published Version
Available under License Creative Commons Attribution Non-commercial No Derivatives.

573kB

Abstract

Navigate PD was an educational program established to supplement existing guidelines and provide recommendations on the management of Parkinson's disease (PD) refractory to oral/transdermal therapies. It involved 103 experts from 13 countries overseen by an International Steering Committee (ISC) of 13 movement disorder specialists. The ISC identified 71 clinical questions important for device-aided management of PD. Fifty-six experts responded to a web-based survey, rating 15 questions as ‘critically important;’ these were refined to 10 questions by the ISC to be addressed through available evidence and expert opinion. Draft guidance was presented at international/national meetings and revised based on feedback. Key take-home points are: • Patients requiring levodopa >5 times daily who have severe, troublesome ‘off’ periods (>1–2 h/day) despite optimal oral/transdermal levodopa or non-levodopa-based therapies should be referred for specialist assessment even if disease duration is <4 years. • Cognitive decline related to non-motor fluctuations is an indication for device-aided therapies. If cognitive impairment is mild, use deep brain stimulation (DBS) with caution. For patients who have cognitive impairment or dementia, intrajejunal levodopa infusion is considered as both therapeutic and palliative in some countries. Falls are linked to cognitive decline and are likely to become more frequent with device-aided therapies. • Insufficient control of motor complications (or drug-resistant tremor in the case of DBS) are indications for device-aided therapies. Levodopa-carbidopa intestinal gel infusions or subcutaneous apomorphine pump may be considered for patients aged >70 years who have mild or moderate cognitive impairment, severe depression or other contraindications to DBS.

Item Type:Articles
Additional Information:On behalf of the National Steering Committees.
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Dietrichs, Mr Erik
Authors: Odin, P., Chaudhuri, K. R., Slevin, J.T., Volkmann, J., Dietrichs, E., Martinez-Martin, P., Krauss, J.K., Henriksen, T., Katzenschlager, R., Antonini, A., Rascol, O., and Poewe, W.
College/School:College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
Journal Name:Parkinsonism and Related Disorders
Publisher:Elsevier
ISSN:1353-8020
ISSN (Online):1873-5126
Published Online:23 July 2015
Copyright Holders:Copyright © 2015 The Authors
First Published:First published in Parkinsonism and Related Disorders 21:1133–1144
Publisher Policy:Reproduced under a creative commons licence

University Staff: Request a correction | Enlighten Editors: Update this record