Developing consensus among movement disorder specialists on clinical indicators for identification and management of advanced Parkinson’s disease: a multi-country Delphi-panel approach

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Developing consensus among movement disorder specialists on clinical indicators for identification and management of advanced Parkinson’s disease : a multi-country Delphi-panel approach. / Antonini, Angelo; Stoessl, A. Jon; Kleinman, Leah S.; Skalicky, Anne M.; Marshall, Thomas S.; Sail, Kavita R.; Onuk, Koray; Odin, Per Lars Anders.

In: Current Medical Research and Opinion, Vol. 34, No. 12, 02.12.2018, p. 2063-2073.

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Antonini, Angelo ; Stoessl, A. Jon ; Kleinman, Leah S. ; Skalicky, Anne M. ; Marshall, Thomas S. ; Sail, Kavita R. ; Onuk, Koray ; Odin, Per Lars Anders. / Developing consensus among movement disorder specialists on clinical indicators for identification and management of advanced Parkinson’s disease : a multi-country Delphi-panel approach. In: Current Medical Research and Opinion. 2018 ; Vol. 34, No. 12. pp. 2063-2073.

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TY - JOUR

T1 - Developing consensus among movement disorder specialists on clinical indicators for identification and management of advanced Parkinson’s disease

T2 - a multi-country Delphi-panel approach

AU - Antonini, Angelo

AU - Stoessl, A. Jon

AU - Kleinman, Leah S.

AU - Skalicky, Anne M.

AU - Marshall, Thomas S.

AU - Sail, Kavita R.

AU - Onuk, Koray

AU - Odin, Per Lars Anders

PY - 2018/12/2

Y1 - 2018/12/2

N2 - Background: Lack of a global consensus on the definition of advanced Parkinson’s disease (APD) and considerations for timing of device-aided therapies may result in heterogeneity in care. Objectives: To reach consensus among movement disorder specialists regarding key patient characteristics indicating transition to APD and guiding appropriate use of device-aided therapies in the management of PD symptoms. Methods: A Delphi-panel approach was utilized to synthesize opinions of movement disorder specialists and build consensus. Results: A panel was comprised of movement disorder specialists from 10 European countries with extensive experience of treating PD patients (mean =24.8 ± 7.2 years). Consensus on indicators of suspected APD and eligibility for device-aided therapies were based on motor symptoms, non-motor symptoms, and functional impairments. Key indicators of APD included: (i) motor—moderate troublesome motor fluctuations, ≥1 h of troublesome dyskinesia/day, ≥2 h “off” symptoms/day, and ≥5-times oral levodopa doses/day; (ii) non-motor—mild dementia, and non-transitory troublesome hallucinations; (iii) functional impairment—repeated falls despite optimal treatment, and difficulty with activities of daily living. Patients with good levodopa response, good cognition, and <70 years of age were deemed as good candidates for all three device-aided therapies. Patients with troublesome dyskinesia were considered good candidates for both levodopa-carbidopa intestinal gel and Deep Brain Stimulation (DBS). PD patients with levodopa-resistant tremor were considered good candidates for DBS. Conclusion: Identifying patients progressing to APD and suitable for device-aided therapies will enable general neurologists to assess the need for referral to movement disorder specialists and improve the quality of care and patient outcomes.

AB - Background: Lack of a global consensus on the definition of advanced Parkinson’s disease (APD) and considerations for timing of device-aided therapies may result in heterogeneity in care. Objectives: To reach consensus among movement disorder specialists regarding key patient characteristics indicating transition to APD and guiding appropriate use of device-aided therapies in the management of PD symptoms. Methods: A Delphi-panel approach was utilized to synthesize opinions of movement disorder specialists and build consensus. Results: A panel was comprised of movement disorder specialists from 10 European countries with extensive experience of treating PD patients (mean =24.8 ± 7.2 years). Consensus on indicators of suspected APD and eligibility for device-aided therapies were based on motor symptoms, non-motor symptoms, and functional impairments. Key indicators of APD included: (i) motor—moderate troublesome motor fluctuations, ≥1 h of troublesome dyskinesia/day, ≥2 h “off” symptoms/day, and ≥5-times oral levodopa doses/day; (ii) non-motor—mild dementia, and non-transitory troublesome hallucinations; (iii) functional impairment—repeated falls despite optimal treatment, and difficulty with activities of daily living. Patients with good levodopa response, good cognition, and <70 years of age were deemed as good candidates for all three device-aided therapies. Patients with troublesome dyskinesia were considered good candidates for both levodopa-carbidopa intestinal gel and Deep Brain Stimulation (DBS). PD patients with levodopa-resistant tremor were considered good candidates for DBS. Conclusion: Identifying patients progressing to APD and suitable for device-aided therapies will enable general neurologists to assess the need for referral to movement disorder specialists and improve the quality of care and patient outcomes.

KW - Continuous subcutaneous apomorphine infusion (CSAI)

KW - Deep brain stimulation (DBS)

KW - Delphi technique

KW - Dyskinesia

KW - Levodopa-Carbidopa Intestinal Gel (LCIG)

KW - Motor fluctuations

KW - Parkinson disease

KW - Patient identification

KW - Wearing-off

U2 - 10.1080/03007995.2018.1502165

DO - 10.1080/03007995.2018.1502165

M3 - Article

VL - 34

SP - 2063

EP - 2073

JO - Current Medical Research and Opinion

JF - Current Medical Research and Opinion

SN - 1473-4877

IS - 12

ER -