Switching and combining device-aided therapies in advanced Parkinson’s disease : a double centre retrospective study

Georgiev, Dejan (author), Delalić, Sentilija (author), Zupančič-Križnar, Nina (author), Socher, Achinoam (author), Gurevich, Tanya (author), Trošt, Maja (author)

Background: Device-aided therapies (DAT), such as continuous subcutaneous apomorphine infusion (CSAI), levodopa-carbidopa intestinal gel infusion (LCIG), and deep brain stimulation of the subthalamic nucleus (STN-DBS), have markedly changed the treatment landscape of advanced Parkinson’s disease (aPD). In some patients, it is necessary to switch or combine DATs for various reasons. The aim of this retrospective study was to explore the frequency and reasons for switching between or combining DATs in two movement disorders centres in Slovenia and Israel. Methods: We collected and analysed demographic and clinical data from aPD patients who switched between or combined DATs. Motor and non-motor reasons, adverse events for switching/combining, and their frequency were examined, as was the effect of DAT using the Global Improvement subscale of the Clinical Global Impression Scale, Movement Disorders Society Unified Parkinson’s Disease Rating Scale part III, Mini Mental State Examination, and Parkinson’s Disease Questionnaire 39. Descriptive statistics and non-parametric tests were used to analyse the data. Results: Of 505 aPD patients treated with DATs at both centres between January 2009 and June 2021, we identified in a total of 30 patients (6%) who either switched DAT (n = 24: 7 LCIG-to-STN−DBS, 1 LCIG-to-CSAI, 5 CSAI-to STN−DBS, 8 CSAI-to-LCIG, 1 STN−DBS-to-LCIG, 1 LCIG-to-CSAI-to-STN−DBS, and 1 STN−DBS-to-CSAI-to-LCIG) or combined DATs (n = 6:5 STN−DBS+LCIG and 1 STN−DBS+CSAI-to-STN−DBS+LCIG). In most of these patients, an inadequate control of motor symptoms was the main reason for switching or combining DATs, but non-motor reasons (related to the disease and/or DAT) were also identified. Conclusions: Switching between and combining DATs is uncommon, but in some patients brings substantial clinical improvement and should be considered in those who have either inadequate symptom control on DAT treatment or have developed DAT-related complications.

• Language: English
• Keywords: advanced Parkinson’s disease, deep brain stimulation of the subthalamic nucleus, L-dopa/carbidopa intestinal gel infusion, continuous subcutaneous apomorphine infusion
• Work type: Article
• Typology: 1.01 - Original Scientific Article
• Organization: FRI - Faculty of Computer and Information Science ; MF - Faculty of Medicine
• Publication status: Published
• Publication version: Version of Record
• Year: 2022
• Number of pages: 10 str.
• Numbering: Vol. 12, iss. 3, art. 343
• PID: 20.500.12556/RUL-137235
• UDC: 616.8
• ISSN on article: 2076-3425
• DOI: 10.3390/brainsci12030343
• COBISS.SI-ID: 99397635
• Publication date in RUL: 08.06.2022

Record is a part of a journal

• Title: Brain sciences
• Shortened title: Brain sci.
• Publisher: MDPI
• ISSN: 2076-3425
• COBISS.SI-ID: 519954201

Licences

• License: CC BY 4.0, Creative Commons Attribution 4.0 International
• Link: http://creativecommons.org/licenses/by/4.0/
• Description: This is the standard Creative Commons license that gives others maximum freedom to do what they want with the work as long as they credit the author.
• Licensing start date: 02.03.2022

Secondary language

• Language: Slovenian
• Keywords: nevrologija, Parkinsonova bolezen, globoka možganska stimulacija, levodopa, motnje gibanja