Parkinsonism and Related Disorders 33 (2016)

 Unmet needs in Parkinson's disease : New horizons in a changing landscape

Authors : K. Ray Chaudhuri, Roongroj Bhidayasiri, Teus van Laar

Abstract : The success of levodopa and other classes of drugs have meant that most people with Parkinson's disease enjoy a good quality of life for many years. However, despite the availability of several drugs and formulations that can be used as monotherapy and in combination, there are a number of disease features that the current therapies are unable to address. The disease continues to progress despite treatment, patients suffer from a myriad of motor and non-motor symptoms, and a neuroprotective therapy is urgently required. To move forward with medical and surgical management, it is important to consider new insights that recent research offers and in this review we examine how a better understanding of the disease pathology and progression might improve and enrich our daily clinical practice. It is also timely to consider the service provision changes that will increasingly be needed to effectively manage the needs of the aging population.

Keyword : Parkinson's disease, Unmet needs, Pathogenesis, Non-motor symptoms, ervice provision

Page : S2 - S8

Quantitative demonstration of the efficacy of night-time apomorphine infusion to treat nocturnal hypokinesia in

Parkinson's disease using wearable sensors

Authors : Roongroj Bhidayasiri, Jirada Sringean, Chanawat Anan, Kamolwan Boonpang, Chusak Thanawattano, K. Ray Chaudhuri

Abstract : 

    Background : Nocturnal hypokinesia/akinesia is one of the common night-time symptoms in patients with Parkinson's disease (PD), negatively affecting quality of life of patients and caregivers. The recognition of this problem and treatment options are limited in clinical practice.

     Objectives : To evaluate the efficacy of nocturnal apomorphine infusion, using a wearable sensor, in patients who are already on daytime continuous subcutaneous apomorphine infusion and still suffer from nocturnal hypokinesia.

     Methods : Nocturnal parameters in 10 PD patients before and during nocturnal infusion were assessed over two nights at their homes, using a wearable sensor (trunk). Nocturnal parameters included number, velocity, acceleration, degree, and duration of rolling over, and number of times they got out of bed. Correlations with validated clinical rating scales were performed.

     Results : Following nocturnal apomorphine infusion (34.8 ± 6.5 mg per night), there were significant improvements in the number of turns in bed (p ¼ 0.027), turning velocity (p ¼ 0.046), and the degree of turning (p ¼ 0.028) in PD patients. Significant improvements of Modified Parkinson's Disease Sleep Scale (p ¼ 0.005), the axial score of Unified Parkinson's Disease Rating Scale (p ¼ 0.013), and Nocturnal Akinesia Dystonia and Cramp Scale (p ¼ 0.014) were also observed.

     Conclusion : Our study was able to demonstrate quantitatively the efficacy of nocturnal apomorphine infusion in PD patients with nocturnal hypokinesia and demonstrated the feasibility of using wearable sensors to yield objective and quantifiable outcomes in a clinical trial setting. More studies are needed to determine the long-term efficacy of this treatment in a large prospective cohort of PD patients.

Keyword : Nocturnal hypokinesia, Nocturnal akinesia, Parkinson's disease, Apomorphine, Getting out of bed, Sensors

Page : S36 - S41

Practical management of adverse events related to apomorphine therapy

Authors : Roongroj Bhidayasiri, Pedro J. Garcia Ruiz, Tove Henriksen

Abstract : The potential for adverse events is often cited as a barrier to the use of subcutaneous apomorphine therapy (intermittent injections and continuous infusion) in the management of Parkinson's disease. However, with proactive management most adverse effects are manageable if reported and tackled early enough. As such, proper clinician and patient awareness of the potential adverse effects is important to minimize their impact on the overall clinical utility of this efficacious antiparkinsonian agent. In this paper, we review the key local and systemic adverse effects reported during apomorphine titration, initiation and long-term treatment, and discuss practical management strategies.

Keyword : Apomorphine, Safety, Tolerability, Adverse events

Page : S42 - S48