Abstract
BackgroundMedicine usage in Parkinson's disease patients is often imperfect, in particular irregular timing of medication. The effect of informing Parkinson's disease patients about the continuous dopaminergic hypothesis (to encourage regular medicine intake) on medication adherence and motor control was tested.MethodsPatients were randomised either to the active group (receiving the intervention) or control group (no extra information). Antiparkinson medicine usage was monitored for 3 months before and after the intervention using electronic pill bottles which record the date and time of opening (MEMS®, Aardex, Switzerland) and data used to calculate the percentage of doses taken at correct time intervals.Results43 patients (52%) were randomised to active counselling, and 40 (48%) were controls (standard management). The intervention effect (difference in timing adherence pre- to post-intervention between the 2 groups) was 13.4% (CI 5.1 to 21.7), p = 0.002. Parkinson motor scores did not change significantly (active group 0.1, CI -3.4 to 3.7) versus controls (4.5, CI 1.6 to 7.1), p = 0.06.ConclusionTiming adherence, but not motor scores, improves by providing patients with extra information. Therapy timing is of potential importance in Parkinson's disease management.Trial registration numberNCT00361205
Highlights
Medicine usage in Parkinson's disease patients is often imperfect, in particular irregular timing of medication
The commonest adverse effects were in declining frequency: insomnia, sleepiness, dyskinesia, and nausea. This is the first study to report an improvement in the timing of tablet intake in Parkinson's Disease, but there was no change in Parkinson motor score, or quality of life scores
Timing adherence improves by providing patients with extra information
Summary
Medicine usage in Parkinson's disease patients is often imperfect, in particular irregular timing of medication. The effect of informing Parkinson's disease patients about the continuous dopaminergic hypothesis (to encourage regular medicine intake) on medication adherence and motor control was tested. Irregular timing of drug ingestion is almost universal[2], perhaps contributed by fluctuating symptoms and drug regimen complexity. Pulsatile dopaminergic stimulation in the basal ganglia is implicated in the development and manifestation of motor complications of advancing PD[4]. The mechanism of motor complications is complex but may relate partly to erratic absorption and short half-life of levodopa causing fluctuating serum and brain drug levels and abnormal pulsatile stimulation of striatal dopamine receptors [5,6] contrasting with more continuous neurone firing under normal circumstances [7,8].
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