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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.

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author
organization
publishing date
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
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
2019-11-05 05:03:00
@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 &lt;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},
  keyword      = {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},
  volume       = {34},
  year         = {2018},
}