Developing consensus among movement disorder specialists on clinical indicators for identification and management of advanced Parkinson’s disease : a multi-country Delphi-panel approach
Antonini, Angelo ; Stoessl, A. Jon ; Kleinman, Leah S. ; Skalicky, Anne M. ; Marshall, Thomas S. ; Sail, Kavita R. ; Onuk, Koray and Odin, Per Lars Anders LU
(2018)
In Current Medical Research and Opinion
34(12).
p.2063-2073
- Abstract
Background: Lack of a global consensus on the definition of advanced Parkinson’s disease (APD) and considerations for timing of device-aided therapies may result in heterogeneity in care. Objectives: To reach consensus among movement disorder specialists regarding key patient characteristics indicating transition to APD and guiding appropriate use of device-aided therapies in the management of PD symptoms. Methods: A Delphi-panel approach was utilized to synthesize opinions of movement disorder specialists and build consensus. Results: A panel was comprised of movement disorder specialists from 10 European countries with extensive experience of treating PD patients (mean =24.8 ± 7.2 years). Consensus on indicators of suspected APD and... (More)
Background: Lack of a global consensus on the definition of advanced Parkinson’s disease (APD) and considerations for timing of device-aided therapies may result in heterogeneity in care. Objectives: To reach consensus among movement disorder specialists regarding key patient characteristics indicating transition to APD and guiding appropriate use of device-aided therapies in the management of PD symptoms. Methods: A Delphi-panel approach was utilized to synthesize opinions of movement disorder specialists and build consensus. Results: A panel was comprised of movement disorder specialists from 10 European countries with extensive experience of treating PD patients (mean =24.8 ± 7.2 years). Consensus on indicators of suspected APD and eligibility for device-aided therapies were based on motor symptoms, non-motor symptoms, and functional impairments. Key indicators of APD included: (i) motor—moderate troublesome motor fluctuations, ≥1 h of troublesome dyskinesia/day, ≥2 h “off” symptoms/day, and ≥5-times oral levodopa doses/day; (ii) non-motor—mild dementia, and non-transitory troublesome hallucinations; (iii) functional impairment—repeated falls despite optimal treatment, and difficulty with activities of daily living. Patients with good levodopa response, good cognition, and <70 years of age were deemed as good candidates for all three device-aided therapies. Patients with troublesome dyskinesia were considered good candidates for both levodopa-carbidopa intestinal gel and Deep Brain Stimulation (DBS). PD patients with levodopa-resistant tremor were considered good candidates for DBS. Conclusion: Identifying patients progressing to APD and suitable for device-aided therapies will enable general neurologists to assess the need for referral to movement disorder specialists and improve the quality of care and patient outcomes.
(Less)
- author
- Antonini, Angelo
; Stoessl, A. Jon
; Kleinman, Leah S.
; Skalicky, Anne M.
; Marshall, Thomas S.
; Sail, Kavita R.
; Onuk, Koray
and Odin, Per Lars Anders
LU
- organization
- publishing date
- 2018-12-02
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- Continuous subcutaneous apomorphine infusion (CSAI), Deep brain stimulation (DBS), Delphi technique, Dyskinesia, Levodopa-Carbidopa Intestinal Gel (LCIG), Motor fluctuations, Parkinson disease, Patient identification, Wearing-off
- in
- Current Medical Research and Opinion
- volume
- 34
- issue
- 12
- pages
- 2063 - 2073
- publisher
- LibraPharm
- external identifiers
-
- scopus:85052075848
- pmid:30016901
- ISSN
- 0300-7995
- DOI
- 10.1080/03007995.2018.1502165
- language
- English
- LU publication?
- yes
- id
- 21301147-d439-44c5-91c5-b6072696a2c2
- date added to LUP
- 2018-10-05 11:04:50
- date last changed
- 2024-06-11 21:13:03
@article{21301147-d439-44c5-91c5-b6072696a2c2,
abstract = {{<p>Background: Lack of a global consensus on the definition of advanced Parkinson’s disease (APD) and considerations for timing of device-aided therapies may result in heterogeneity in care. Objectives: To reach consensus among movement disorder specialists regarding key patient characteristics indicating transition to APD and guiding appropriate use of device-aided therapies in the management of PD symptoms. Methods: A Delphi-panel approach was utilized to synthesize opinions of movement disorder specialists and build consensus. Results: A panel was comprised of movement disorder specialists from 10 European countries with extensive experience of treating PD patients (mean =24.8 ± 7.2 years). Consensus on indicators of suspected APD and eligibility for device-aided therapies were based on motor symptoms, non-motor symptoms, and functional impairments. Key indicators of APD included: (i) motor—moderate troublesome motor fluctuations, ≥1 h of troublesome dyskinesia/day, ≥2 h “off” symptoms/day, and ≥5-times oral levodopa doses/day; (ii) non-motor—mild dementia, and non-transitory troublesome hallucinations; (iii) functional impairment—repeated falls despite optimal treatment, and difficulty with activities of daily living. Patients with good levodopa response, good cognition, and <70 years of age were deemed as good candidates for all three device-aided therapies. Patients with troublesome dyskinesia were considered good candidates for both levodopa-carbidopa intestinal gel and Deep Brain Stimulation (DBS). PD patients with levodopa-resistant tremor were considered good candidates for DBS. Conclusion: Identifying patients progressing to APD and suitable for device-aided therapies will enable general neurologists to assess the need for referral to movement disorder specialists and improve the quality of care and patient outcomes.</p>}},
author = {{Antonini, Angelo and Stoessl, A. Jon and Kleinman, Leah S. and Skalicky, Anne M. and Marshall, Thomas S. and Sail, Kavita R. and Onuk, Koray and Odin, Per Lars Anders}},
issn = {{0300-7995}},
keywords = {{Continuous subcutaneous apomorphine infusion (CSAI); Deep brain stimulation (DBS); Delphi technique; Dyskinesia; Levodopa-Carbidopa Intestinal Gel (LCIG); Motor fluctuations; Parkinson disease; Patient identification; Wearing-off}},
language = {{eng}},
month = {{12}},
number = {{12}},
pages = {{2063--2073}},
publisher = {{LibraPharm}},
series = {{Current Medical Research and Opinion}},
title = {{Developing consensus among movement disorder specialists on clinical indicators for identification and management of advanced Parkinson’s disease : a multi-country Delphi-panel approach}},
url = {{http://dx.doi.org/10.1080/03007995.2018.1502165}},
doi = {{10.1080/03007995.2018.1502165}},
volume = {{34}},
year = {{2018}},
}