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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, Per LU ; Ray Chaudhuri, K; Slevin, J T; Volkmann, J; Dietrichs, E; Martinez-Martin, P; Krauss, J K; Henriksen, T; Katzenschlager, R and Antonini, A, et al. (2015) In Parkinsonism & Related Disorders 21(10). p.1133-1144
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 Draft guidance was presented at international/national meetings and revised based on feedback.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: •... (More)
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 Draft guidance was presented at international/national meetings and revised based on feedback.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. (Less)
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Parkinsonism & Related Disorders
volume
21
issue
10
pages
1133 - 1144
publisher
Elsevier
external identifiers
  • pmid:26233582
  • wos:000362858600002
  • scopus:84942191840
ISSN
1873-5126
DOI
10.1016/j.parkreldis.2015.07.020
language
English
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yes
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5a488d9a-c4d8-4787-984d-9eff8e8a8a9a (old id 7845019)
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http://www.ncbi.nlm.nih.gov/pubmed/26233582?dopt=Abstract
date added to LUP
2015-09-03 19:13:49
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2017-11-12 03:14:12
@article{5a488d9a-c4d8-4787-984d-9eff8e8a8a9a,
  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 &gt;5 times daily who have severe, troublesome 'off' periods (&gt;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 &lt;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 &gt;70 years who have mild or moderate cognitive impairment, severe depression or other contraindications to DBS.},
  author       = {Odin, Per and Ray Chaudhuri, K and Slevin, J T and Volkmann, J and Dietrichs, E and Martinez-Martin, P and Krauss, J K and Henriksen, T and Katzenschlager, R and Antonini, A and Rascol, O and Poewe, W},
  issn         = {1873-5126},
  language     = {eng},
  number       = {10},
  pages        = {1133--1144},
  publisher    = {Elsevier},
  series       = {Parkinsonism & Related Disorders},
  title        = {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.},
  url          = {http://dx.doi.org/10.1016/j.parkreldis.2015.07.020},
  volume       = {21},
  year         = {2015},
}