scholarly journals Advanced Parkinson’s Disease Treatment Simplification and Long-Term Outcomes with Levodopa Carbidopa Intestinal Gel: COSMOS Romanian Subanalysis

2021 ◽  
Vol 11 (12) ◽  
pp. 1566
Author(s):  
Mihaela Adriana Simu ◽  
Dragos Catalin Jianu ◽  
Adriana Octaviana Dulamea ◽  
Viorelia Adelina Constantin ◽  
Diana Popescu ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Long Term Outcomes ◽  
Disease Treatment ◽  
Cross Sectional ◽  
Advanced Parkinson’S Disease ◽  
Retrospective Data Collection ◽  
The Moment ◽  
Treatment Simplification

The aim of the COmedication Study assessing Mono- and cOmbination therapy with levodopa-carbidopa inteStinal gel (COSMOS) was to assess the use of levodopa/carbidopa intestinal gel (LCIG) as monotherapy in patients with advanced Parkinson’s disease (APD) in routine clinical practice. COSMOS was an international observational study with one cross-sectional visit and retrospective data collection. In Romania, 95 adult patients with APD on LCIG treatment for at least 12 months were enrolled and stratified according to their LCIG therapy after 12 months: monotherapy (without any add-on PD medication), monotherapy with night PD medication and LCIG + add-on medication. Compared to the moment of LCIG initiation, the percentage of patients on monotherapy increased at three months after LCIG initiation and remained constant up to 12 months, when 30.5% of the patients were on LCIG monotherapy and 11.6% were on monotherapy with night medication. “Off” time and “On” time with dyskinesia decreased from LCIG initiation to patient visit in all groups. LCIG monotherapy with or without night medication may provide a simplified treatment option for selected APD patients, with long-term efficacy similar to that of LCIG plus add-on medication.

Long-Term Outcomes of Bilateral Subthalamic Nucleus Stimulation in Patients with Advanced Parkinson’s Disease

2006 ◽  
Vol 84 (5-6) ◽  
pp. 221-227 ◽  
Author(s):  
Grace S. Liang ◽  
Kelvin L. Chou ◽  
Gordon H. Baltuch ◽  
Jurg L. Jaggi ◽  
Catherine Loveland-Jones ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Subthalamic Nucleus ◽  
Long Term Outcomes ◽  
Advanced Parkinson’S Disease ◽  
Subthalamic Nucleus Stimulation

Evidence for Early and Regular Physical Therapy and Exercise in Parkinson's Disease

2021 ◽  
Author(s):  
Terry D. Ellis ◽  
Cristina Colón-Semenza ◽  
Tamara R. DeAngelis ◽  
Cathi A. Thomas ◽  
Marie-Hélène Saint Hilaire ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Physical Therapy ◽  
Secondary Prevention ◽  
Medical Management ◽  
Long Term Outcomes ◽  
High Prevalence ◽  
Growing Body ◽  
Prevention Model

AbstractAdvances in medical management of Parkinson's disease (PD) have resulted in living longer with disability. Although disability worsens over the course of the disease, there are signs of disability even in the early stages. Several studies reveal an early decline in gait and balance and a high prevalence of nonmotor signs in the prodromal period that contribute to early disability. There is a growing body of evidence revealing the benefits of physical therapy and exercise to mitigate motor and nonmotor signs while improving physical function and reducing disability. The presence of early disability coupled with the benefits of exercise suggests that physical therapy should be initiated earlier in the disease. In this review, we present the evidence revealing early disability in PD and the effectiveness of physical therapy and exercise, followed by a discussion of a secondary prevention model of rehabilitation to reduce early disability and optimize long-term outcomes.

Long term follow-up in advanced Parkinson’s disease treated with DBS of the subthalamic nucleus

2021 ◽  
Author(s):  
Maria Antonietta Volonté ◽  
Giacomo Clarizio ◽  
Sebastiano Galantucci ◽  
Pietro Giuseppe Scamarcia ◽  
Rosalinda Cardamone ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Subthalamic Nucleus ◽  
Advanced Parkinson’S Disease ◽  
Long Term Follow Up

Risperidone in levodopa-induced psychosis in advanced parkinson's disease: An open-label, long-term study

1997 ◽  
Vol 12 (4) ◽  
pp. 610-612 ◽  
Author(s):  
Giuseppe Meco ◽  
Andrea Alessandri ◽  
Patrizia Giustini ◽  
Vincenzo Bonifati
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Open Label ◽  
Term Study ◽  
Advanced Parkinson’S Disease ◽  
Long Term Study

scholarly journals PEG-J replacement for duodenal levodopa infusion in Parkinson’s disease patients: a retrospective study

BMC Neurology ◽  
2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Simone Simoni ◽  
Pasquale Nigro ◽  
Marta Filidei ◽  
Giulia Cappelletti ◽  
Federico Paolini Paoletti ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Retrospective Study ◽  
Protective Factor ◽  
T Test ◽  
Advanced Parkinson’S Disease ◽  
Peristomal Complications ◽  
Duodenal Levodopa Infusion ◽  
Complications And Mortality

Abstract Background Reducing percutaneous endoscopic gastrostomies with jejunal extension tubes (PEG-J) related complications is vital to the long-term preservation of duodenal levodopa infusion (DLI) in advanced Parkinson’s disease (APD). Here, we provide data on the frequency of complications for both the standard “pull” and the non-endoscopic, radiologic assisted, “push” replacement PEG-J techniques in APD. Methods We retrospectively identified all patients treated with DLI from October 2009 to January 2020 at the Movement Disorders Center. Patients features and demographics, PEG-J procedures, causes for any discontinuation, reported complications and mortality were collected. In this cohort, PEG-J replacements were performed using the standard “pull” procedure or the radiologic assisted “push” method. Descriptive statistical analysis, t-test and paired t-test with False Discovery Rate correction was performed. Results This retrospective study included 30 APD patients [median age 72 ± 5.6 years; mean disease duration 17.2 + 5.7 years]. Mean treatment duration was 35.6 (30.6) months. Overall, 156 PEG-J procedures were performed, and Nineteen patients (63.3%) had a total of 185 reported complications, 85 of which were peristomal complications. 17 (56.6%) underwent 100 replacement procedures due to complications. The most commonly reported complication for replacement was J-tube dislocation (36%). One patient discontinued treatment after 6 months, due to peripheral neuropathy. Six patients died for causes not related to DLI. PEG-J replacements performed with the “push” method had a higher turnover (5.6 vs. 7.6 mo.), but fewer reported complications (67 vs. 75%). Conclusion The overall rate of complications was lower for “push” technique. This result might have been due to a higher replacement turnover that acted as a protective factor.

scholarly journals Comparison of elderly and young patient populations treated with deep brain stimulation for Parkinson’s disease: long-term outcomes with up to 7 years of follow-up

2019 ◽  
Vol 131 (3) ◽  
pp. 807-812 ◽  
Author(s):  
Joshua A. Hanna ◽  
Tyler Scullen ◽  
Lora Kahn ◽  
Mansour Mathkour ◽  
Edna E. Gouveia ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Elderly Patients ◽  
Motor Function ◽  
The Elderly ◽  
Young Group ◽  
Long Term Outcomes ◽  
Deep Brain

OBJECTIVEDeep brain stimulation (DBS) is the procedure of choice for Parkinson’s disease (PD). It has been used in PD patients younger than 70 years because of better perceived intra- and postoperative outcomes than in patients 70 years or older. However, previous studies with limited follow-up have demonstrated benefits associated with the treatment of elderly patients. This study aims to evaluate the long-term outcomes in elderly PD patients treated with DBS in comparison with a younger population.METHODSPD patients treated with DBS at the authors’ institution from 2008 to 2014 were divided into 2 groups: 1) elderly patients, defined as having an age at surgery ≥ 70 years, and 2) young patients, defined as those < 70 years at surgery. Functional and medical treatment outcomes were evaluated using the Unified Parkinson’s Disease Rating Scale part III (UPDRS III), levodopa-equivalent daily dose (LEDD), number of daily doses, and number of anti-PD medications. Study outcomes were compared using univariate analyses, 1-sample paired t-tests, and 2-sample t-tests.RESULTSA total of 151 patients were studied, of whom 24.5% were ≥ 70 years. The most common preoperative Hoehn and Yahr stages for both groups were 2 and 3. On average, elderly patients had more comorbidities at the time of surgery than their younger counterparts (1 vs 0, p = 0.0001) as well as a higher average LEDD (891 mg vs 665 mg, p = 0.008). Both groups experienced significant decreases in LEDD following surgery (elderly 331.38 mg, p = 0.0001; and young 108.6 mg, p = 0.0439), with a more significant decrease seen in elderly patients (young 108.6 mg vs elderly 331.38 mg, p = 0.0153). Elderly patients also experienced more significant reductions in daily doses (young 0.65 vs elderly 3.567, p = 0.0344). Both groups experienced significant improvements in motor function determined by reductions in UPDRS III scores (elderly 16.29 vs young 12.85, p < 0.0001); however, reductions in motor score between groups were not significant. Improvement in motor function was present for a mean follow-up of 3.383 years postsurgery for the young group and 3.51 years for the elderly group. The average follow-up was 40.6 months in the young group and 42.2 months in the elderly group.CONCLUSIONSThis study found long-term improvements in motor function and medication requirements in both elderly and young PD patients treated with DBS. These outcomes suggest that DBS can be successfully used in PD patients ≥ 70 years. Further studies will expand on these findings.

scholarly journals Bromocriptine in the Long-Term Management of Advanced Parkinson’s Disease

1983 ◽  
Vol 10 (2) ◽  
pp. 86-90 ◽  
Author(s):  
J. David Grimes ◽  
Mohamed N. Hassan
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Dosage Adjustment ◽  
Peak Effect ◽  
Advanced Parkinson’S Disease ◽  
Sustained Improvement ◽  
Main Adverse Effect ◽  
Late Withdrawal ◽  
Term Benefit

SUMMARY:Thirty-seven patients with advanced Parkinson’s disease who initially tolerated, and responded to bromocriptine therapy were followed for 12 to 50 (mean 28) months. Using a method of gradual increase of bromocriptine, with concomitant levodopa reduction, the peak effect of the drug was apparent by three months, at which time the mean daily dose of bromocriptine was 23.9 mg and Sinemet (levodopa + carbidopa) had been reduced by 34 percent.Eight patients had sustained improvement without further drug changes for an average of 29 (range 14–50) months. After periods of improvement varying between 3 and 30 months, 29 patients had a fall-off from peak effect. Peak effect was regained in 21 of these 29 patients for an average of 16 additional months by initially increasing bromocriptine or Sinemet, or by eventually increasing both drugs. The main adverse effect was a confusional state which necessitated late withdrawal of bromocriptine in four patients. The best results were in younger patients with end-of-dose deterioration and levodopa induced dyskinesias.With cautious introduction, and intermittent dosage adjustment, bromocriptine can be of long-term benefit to patients with advanced Parkinson’s disease. The majority of patients have a gradual late fall-off in effect which can frequently be reversed with dosage adjustment.

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