Abstract
Device-aided therapies, including levodopa-carbidopa intestinal gel infusion, apomorphine subcutaneous infusion, and deep brain stimulation, are available in many countries for the management of the advanced stage of Parkinson’s disease (PD). Currently, selection of device-aided therapies is mainly focused on patients’ motor profile while non-motor symptoms play a role limited to being regarded as possible exclusion criteria in the decision-making process for the delivery and sustenance of a successful treatment. Differential beneficial effects on specific non-motor symptoms of the currently available device-aided therapies for PD are emerging and these could hold relevant clinical implications. In this viewpoint, we suggest that specific non-motor symptoms could be used as an additional anchor to motor symptoms and not merely as exclusion criteria to deliver bespoke and patient-specific personalised therapy for advanced PD.
Highlights
Parkinson’s Foundation Centre of Excellence, King’s College Hospital, London SE5 9RS, UK; Department of Neurology, Faculty of Medicine, University of Cologne, 50937 Cologne, Germany; Department of Neurology, Neurosurgery and Medical Genetics, Federal State Autonomous Educational
While therapeutic decisions and research on DAT have largely focused on the influence and effect on motor symptoms, NMS are an integral feature of Parkinson’s disease (PD) and, should play an active part in the decision-making process to select the ideal DAT for patients with
APO has been in use longest compared with DBS and LCIG (APO became available on the European market in the early 1990s), data regarding APO and selection of this device-aided therapy based on patients’ non-motor profile is less obvious and the results from the double-blind TOLEDO study are awaited with interest [60]
Summary
Parkinson’s disease (PD) is a heterogenous syndromic disorder with a complex natural history, spanning prodromal to palliative stages [1,2]. A recent initiative based on an international Delphi-panel approach identified key motor, non-motor, and functional indicators of advanced PD [10], externally validated in the OBSERVE-PD study [11]. DBS is often not considered because of risk-benefit uncertainty, may benefit from a modified approach involving DBS of several nuclei [16] Another emergent debate is focused on how non-motor symptoms (NMS) may guide DAT selection for patients with. The costs of DAT can be considerable, but NMS have not been taken into account in cost-effectiveness analyses [18] This is a relevant observation as NMS contribute at least if not more, to quality of life as motor symptoms [19,20]. We aim to delineate the emerging field of non-motor indications for DAT and discuss possible implications for clinical practice
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