TY - JOUR
T1 - Collective physician perspectives on non-oral medication approaches for the management of clinically relevant unresolved issues in Parkinson's disease
T2 - Consensus from an international survey and discussion program
AU - Odin, P
AU - Ray Chaudhuri, K
AU - Slevin, J T
AU - Volkmann, J
AU - Dietrichs, E
AU - Martinez-Martin, P
AU - Krauss, J K
AU - Henriksen, T
AU - Katzenschlager, R
AU - Antonini, A
AU - Rascol, O
AU - Poewe, W
AU - National Steering Committees
A2 - Jespersen, Holger
A2 - Kamal, Akram
A2 - Karlsborg, Merete
A2 - Oppel, Lorenz Martin
A2 - Pedersen, Stephen
A2 - Avikainen, Sari
A2 - Kaasinen, Valtteri
A2 - Pekkonen, Eero
A2 - Ruottinen, Hanna
A2 - Azulay, Jean-Philippe
N1 - Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.
PY - 2015
Y1 - 2015
N2 - 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 Draft guidance was presented at international/national meetings and revised based on feedback.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.
AB - 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.
U2 - 10.1016/j.parkreldis.2015.07.020
DO - 10.1016/j.parkreldis.2015.07.020
M3 - Review article
C2 - 26233582
SN - 1353-8020
VL - 21
SP - 1133
EP - 1144
JO - Parkinsonism & Related Disorders
JF - Parkinsonism & Related Disorders
IS - 10
ER -