Treatment of Advanced Parkinson's Disease

Patients at late stage Parkinson's disease (PD) develop several motor and nonmotor complications, which dramatically impair their quality of life. These complications include motor fluctuations, dyskinesia, unpredictable or absent response to medications, falls, dysautonomia, dementia, hallucinations, sleep disorders, depression, and psychosis. The therapeutic management should be driven by the attempt to create a balance between benefit and side effects of the pharmacological treatments available. Supportive care, including physical and rehabilitative interventions, speech therapy, occupational therapy, and nursing care, has a key role in the late stage of disease. In this review we discuss the several complications experienced by advance PD patients and their management. The importance of an integrative approach, including both pharmacological and supportive interventions, is emphasized.

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Long-term effectiveness of levodopa-carbidopa intestinal gel on motor and non-motor symptoms in advanced Parkinson’s disease: results of the Italian GLORIA patient population

Neurological Sciences ◽

10.1007/s10072-020-04401-w ◽

2020 ◽

Vol 41 (10) ◽

pp. 2929-2937 ◽

Cited By ~ 1

Author(s):

Angelo Antonini ◽

Pietro Marano ◽

Graziano Gusmaroli ◽

Nicola Modugno ◽

Claudio Pacchetti ◽

...

Keyword(s):

Quality Of Life ◽

Parkinson’S Disease ◽

Parkinson's Disease ◽

Rating Scale ◽

Motor Fluctuations ◽

Motor Symptoms ◽

Italian Population ◽

Advanced Parkinson’S Disease ◽

Non Motor Symptoms

Abstract Introduction The GLORIA registry included 375 advanced Parkinson’s disease (PD) patients and evaluated the efficacy and safety of a 24-month levodopa-carbidopa intestinal gel (LCIG) treatment in routine medical care. This analysis focuses on the Italian population, 60 patients treated with LCIG in 7 specialised PD care centres. Methods Hours of “Off” and “On” time were assessed with a modified version of the Unified Parkinson’s Disease Rating Scale (UPDRS) part IV items 39 and 32. Motor fluctuations, dyskinesia, non-motor symptoms, quality of life and safety were evaluated. Results Overall, 42 (70%) out of 60 patients completed the registry. LCIG treatment reduced “Off” time (− 3.3 ± 2.7 h at month 24 (M24), P < 0.0001), increased “On” time with dyskinesia (− 2.6 ± 5.2 h at M12, P = 0.0160), and improved UPDRS II and UPDRS III total scores at M24 (− 4.5 ± 10.6, P = 0.0333 and − 4.9 ± 11.7, P = 0.0229, respectively), Non-Motor Symptom Scale (NMSS) total score (− 21.8 ± 28.5, P < 0.0001) and Parkinson’s Disease Questionnaire-8 item (PDQ-8) total score (− 12.5 ± 23.9, P = 0.0173) versus previous oral therapy. Adverse drug reactions (ADR) possibly or probably related to treatment were reported in 16 (28.6%) patients. Decreased weight (7.1%), polyneuropathy (7.1%) and abdominal pain (5.4%) were the most frequent ADRs while device malfunction (5.4%) and medical device change (5.4%) were the most reported device complaints. Conclusions LCIG improved motor fluctuations, non-motor symptoms and quality of life over 24 months while tolerability was consistent with the established safety profile.

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Management Challenges of Severe, Complex Dyskinesia. Data from a Large Cohort of Patients Treated with Levodopa-Carbidopa Intestinal Gel for Advanced Parkinson’s Disease

Brain Sciences ◽

10.3390/brainsci11070826 ◽

2021 ◽

Vol 11 (7) ◽

pp. 826

Author(s):

József Attila Szász ◽

Viorelia Adelina Constantin ◽

Károly Orbán-Kis ◽

Ligia Ariana Bancu ◽

Marius Ciorba ◽

...

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Motor Fluctuations ◽

Advanced Parkinson’S Disease ◽

Number Of Patients ◽

Before And After ◽

Advanced Stages ◽

Complex Forms ◽

Time Of Administration

Background: In the advanced stages of Parkinson’s disease (APD), complex forms of dyskinesia may severely impair the patient’s quality of life. Objective: In the present study, we aimed to analyze the evolution under LCIG therapy of the most important motor fluctuations and complex disabling dyskinesias, including diphasic dyskinesia. Methods: In this retrospective study, we analyzed the characteristics of patients with APD who had at least 30 min of diphasic dyskinesia (DID) in 3 consecutive days, were considered responders and were treated with LCIG in our clinic. Patients were evaluated before and after PEG and at 6, 12 and 18 months, when the changes in the therapy were recorded, and they completed a 7-point Global Patient Impression of Improvement (PGI-I) scale. Results: Forty patients fulfilled the inclusion criteria—out of which, 34 performed all visits. There was a substantial difference between the calculated and real LCIG (1232 ± 337 mg vs. 1823 ± 728 mg). The motor fluctuations and most dyskinesias improved significantly after starting LCIG, but an increasing number of patients needed longer daily administrations of LCIG (24 instead of 16 h). Conclusions: Patients with APD with complex dyskinesias must be tested in dedicated hospitals, and they need a special therapeutic approach. The properly adapted LCIG treatment regarding the dose and time of administration completed with well-selected add-on medication should offer improvement for patients who want to or can only choose this DAT vs. others.

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Factors Associated with Health‐Related Quality of Life in Late‐Stage Parkinson's Disease

Movement Disorders Clinical Practice ◽

10.1002/mdc3.13186 ◽

2021 ◽

Author(s):

Kristina Rosqvist ◽

Per Odin ◽

Stefan Lorenzl ◽

Wassilios G. Meissner ◽

Bastiaan R. Bloem ◽

...

Keyword(s):

Quality Of Life ◽

Parkinson’S Disease ◽

Parkinson's Disease ◽

Late Stage ◽

Health Related Quality ◽

Factors Associated ◽

Related Quality ◽

Health Related

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Nighttime levodopa infusions to treat motor fluctuations in advanced parkinson's disease: Preliminary observations

Annals of Neurology ◽

10.1002/ana.410300417 ◽

1991 ◽

Vol 30 (4) ◽

pp. 616-617 ◽

Cited By ~ 9

Author(s):

Jacob I. Sage ◽

Margery H. Mark

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Motor Fluctuations ◽

Advanced Parkinson’S Disease

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Az orális levodopakezelés jellegzetességei előrehaladott Parkinson-kórban a marosvásárhelyi neurológiai klinikák tapasztalatában

Orvosi Hetilap ◽

10.1556/650.2019.31354 ◽

2019 ◽

Vol 160 (17) ◽

pp. 662-669 ◽

Cited By ~ 1

Author(s):

József Attila Szász ◽

Szabolcs Szatmári ◽

Viorelia Constantin ◽

István Mihály ◽

Attila Rácz ◽

...

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Multidisciplinary Teams ◽

Motor Complications ◽

Levodopa Dose ◽

Advanced Parkinson’S Disease ◽

Upper Limits ◽

Severe Motor ◽

Administration Rate

Abstract: Introduction: The motor and non-motor complications of Parkinson’s disease impair the patients’ quality of life and limit therapeutical options. There are no clear criteria for ‘advanced’ Parkinson’s disease or for the optimal moment for invasive therapies. There is little evidence regarding the upper limits of levodopa doses, and how these may be influenced by the availability of device-aided therapies. Aim: To analyze substitution therapy in patients with advanced Parkinson’s disease. Method: In our retrospective study, we analyzed the data from all patients with advanced Parkinson’s disease hospitalized between 1st June 2011 and 31st May 2017, receiving combined levodopa treatment at least 4×/day, reporting a minimum of 2 hours off periods, with or without dyskinesia. We analyzed levodopa therapy for patients who were recommended either device-aided or conservative therapy. Results: Out of 311 patients with advanced Parkinson’s disease, for 125 we proposed device-aided therapies whereas in 42 patients we increased the levodopa dose. The average levodopa doses and the administration rate were higher for the 107 patients tested for levodopa-carbidopa intestinal gel. Disease duration, mean levodopa doses and frequency of dosing were all higher in patients proposed for device-aided therapies versus patients with continued conservative treatment. Conclusion: Our patients were on lower levodopa doses (compared to literature), but the combinations were used more often. Device-aided therapies should be considered in patients with severe motor complications who receive at least 750–1000 mg levodopa daily, divided minimum 5×/day. These patients need to be tested in specialized centers by multidisciplinary teams in order to make the best decision for further action. Orv Hetil. 2019; 160(17): 662–669.

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Effect of Electroacupuncture on Function and Quality of Life in Parkinson's Disease: A Case Report

Acupuncture in Medicine ◽

10.1136/acupmed-2012-010285 ◽

2013 ◽

Vol 31 (2) ◽

pp. 235-238 ◽

Cited By ~ 5

Author(s):

Dhananjay Vijay Arankalle ◽

Pradeep M K Nair

Keyword(s):

Quality Of Life ◽

Parkinson’S Disease ◽

Parkinson's Disease ◽

Activities Of Daily Living ◽

Daily Living ◽

Integrative Approach ◽

Emotional Instability ◽

Subjective Health Status ◽

Yahr Stage

A 56-year-old man diagnosed in 2003 as having Hoehn & Yahr stage III Parkinson's disease (PD) came to our clinic in 2012 with slurred speech, right-sided bradykinesia, erectile dysfunction, rigidity, emotional instability and depression. His PD showed progressive signs with postural instability, moderate bilateral signs, and he rated 80% on the Schwab & England Activities of Daily Living Scale. A modified protocol of electroacupuncture was administered for a period of 5 weeks, six times per week, with each session lasting for 30 min. Assessments were based on the Berg Balance Scale (BBS) and Parkinson's Disease Questionnaire-39 (PDQ-39) items, a disease-specific measure of subjective health status. He showed improvement on the BBS, suggesting improved functional status. His quality of life showed improvement particularly on the ‘activities of daily living’, ‘cognition’ and ‘communication’ dimensions of the PDQ-39. Acupuncture treatments in animal experiments have generated valuable mechanistic insights that could be relevant to PD, for example, demonstrating its neuroprotective potential from stimulation of various neuroprotective agents. The literature also suggests acupuncture may play a role in the improvement of motor function and quality of life in PD. Acupuncture is tolerated well by individuals with PD and should be considered as an integrative approach for their symptomatic management.

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