TEMP - Therapy Escalation in M. Parkinson - A German Regional Multicenter Survey

Abstract

Objective: To characterize socio-demographic and disease-specific data of Parkinson’s disease patients before and 1 year after therapy escalation with subcutaneous apomorphine (APO), levodopa/carbidopa intestinal gel (LCIG), or subthalamic deep brain stimulation (STN-DBS) in an observation trial under real life conditions. Methods: Between 2014-2015, patients undergoing therapy escalation were consecutively included in 5 movement disorders centers. Motor and nonmotor symptoms were scored before and 1 year following initiation of invasive treatments. Therapy adherence, changes of scores and oral medication were evaluated. Results: In this open-label, prospective, 12-months, multicenter real-lifestudy 63 patients were included. 31 received DBS, 19 were commenced on LCIG, 15 received treatment with APO. 16 patients were lost for follow-up. Therapy adherence after one year in the STN-DBS-group was 100%, in the LCIG-group 87.5%, and in the APO-group 47%. Therapy termination in the APO-cohort was due to onset of hallucinations, orthostatic hypotension and inflammatory skin lesions and necrosis. After one year, UPDRS-III scores improved for STN-DBS patients. All groups gained ON-time with no differences between the 3 arms. STN-DBS patients had less ON-time with dyskinesia compared to APO- and LCIG-patients. Levodopa daily dose was decreased by 50% in STN-DBS patients, and 33% in APO patients, respectively. Conclusion: All three escalation options improved ON-time. Therapy adherence in the APO-group was less than 50% after 1 year, making it a potential bridging option while awaiting a more invasive treatment.