In a recent study, researchers investigated the clinical effectiveness of three different device-assisted therapies for people with Parkinson’s Disease experiencing motor fluctuations and dyskinesias. The team found beneficial effects of all three treatment options. Keen to find out more? Read our summary here.
Device assisted therapies for treatment of patients with Parkinson’s disease
In the early stages of PD, most patients experience substantial benefit with medical therapy and exercise, achieving a 60-80% improvement of physical symptoms with consistent control through the day.
Over years, however, symptom control can become inconsistent and is sometimes accompanied by periods of excessive movement called ‘dyskinesia’.
Medication adjustments can be effective in ironing out these motor fluctuations and dyskinesia, however in the longer term, some patients find that consistent symptom control cannot be achieved even after altering their medications.
At this stage, a second tier of therapies can be effective in regaining consistent control of Parkinson’s symptoms and reducing dyskinesia. These therapies are delivered by medical devices and are collectively referred to as ‘Device Assisted Therapies’.
Currently, there are three device assisted therapies with proven efficacy in patients with motor fluctuations and dyskinesias:
· Deep Brain Stimulation (DBS)
· Apomorphine infusion (Apo)
· Intrajejunal levodopa infusion (IJLI)
Whilst all three therapies have been examined using the gold standard study format for medical interventions (a blinded randomised placebo controlled trial), head to head comparisons of all three therapies have not been previously performed.
In a recent study, researchers investigated the clinical effectiveness of the three different device-assisted therapies for people with Parkinson’s Disease experiencing motor fluctuations and dyskinesias.
The researchers observed 173 people in total who were undergoing:
· Bilateral subthalamic stimulation (STN-DBS) – 101 people
· Apomorphine (APO) – 39 people
· Intrajejunal levodopa infusion (IJLI) – 33 people.
The research, which is the first real-life comparison in people with Parkinson’s Disease undergoing device assisted therapies was published in the journal Movement Disorders. Link to summary here https://www.ncbi.nlm.nih.gov/pubmed/30719763
Importantly, the study examined and compared the effects of the three therapies on a broad range of PD symptoms aswell as quality of life. Specifically, the study examined and compared the effect of each of the therapies on:
· Physical (motor) symptoms
· Non-motor symptoms (cognition, mood, bladder and bowel, sleep disturbance & pain)
· Quality of Life
As had been demonstrated in earlier studies, all three therapies were effective in reducing motor fluctuations and dyskinesias and improving quality of life. Each therapy was however associated with a different profile of improvement of non-motor symptoms
· STN-DBS improved urinary and sexual functions, mood/cognition, sleep/fatigue, and the miscellaneous domain (pain, sense of taste and smell, weight change, excessive sweating)
· IJLI improved the mood/cognition, sleep/fatigue, miscellaneous and gastrointestinal symptoms.
· APO improved mood/cognition, perceptual problems/hallucinations, attention/memory, and the miscellaneous domain.
“Our results highlight the importance of holistic assessments of motor as well as nonmotor aspects of Parkinson’s Disease that could provide a means to personalise treatment options to patients’ individual Parkinson’s Disease profiles,” the researchers wrote.
This work assists clinicians in providing optimal recommendations regarding device assisted therapies, taking into account the full profile of an individual patient’s symptoms.