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

P. Odin*, K. Ray Chaudhuri, J. T. Slevin, J. Volkmann, E. Dietrichs, P. Martinez-Martin, J. K. Krauss, T. Henriksen, R. Katzenschlager, A. Antonini, O. Rascol, W. Poewe, Thomas Brücke, Walter Pirker, Gerhard Ransmayr, Petra Schwingenschuh, Volker Tomantschger, Dieter Volc, Holger Jespersen, Akram KamalMerete Karlsborg, Lorenz Oppel, Stephen Pedersen, Sari Avikainen, Valtteri Kaasinen, Eero Pekkonen, Hanna Ruottinen, Jean Philippe Azulay, Jean Christophe Corvol, Christine Brefel Courbon, Luc Defebvre, Franck Durif, Jean Luc Houeto, Paul Krack, François Tison, Jürgen Andrich, Reinhard Ehret, Fabian Klostermann, Rejko Krüger, Paul Lingor, Robert Liszka, Johannes Schwarz, Lars Timmermann, Tobias Warnecke, Sevasti Bostantjopoulou, Spyridon Konitsiotis, Sokratis Papageorgiou, Pantelis Stathishens, Leonidas Stefanis, Panagiotis Zikos, On behalf of the National Steering Committees

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

123 Citations (Scopus)

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 Draft guidance was presented at international/national meetings and revised based on feedback.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 >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.

Original languageEnglish
Article number2748
Pages (from-to)1133-1144
Number of pages12
JournalParkinsonism and Related Disorders
Volume21
Issue number10
DOIs
Publication statusPublished - 1 Oct 2015
Externally publishedYes

Keywords

  • Device-aided therapies
  • Dyskinesias
  • Motor fluctuations
  • Non-motor symptoms
  • Parkinson's disease

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