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Experts at EFNS 2012 Symposium believe earlier initiation of continuous dopaminergic stimulation (CDS) therapy is beneficial in advanced Parkinson's disease (PD)
05 October 2012
Almost a third (31%) of the 400 plus delegates attending a symposium(1) held at the 16th Congress of the European Federation of Neurological Societies (EFNS) in Stockholm recently, voted in favour of initiating CDS therapy at the ‘early complications stage’ of Parkinson's disease (PD), rather than waiting for later-stage disease to develop.
Chairmen Per Odin, (Department of Neurology, Klinikum-Bremerhaven, Germany and the Department of Neurology, Lund University Hospital, Sweden) and K Ray Chaudhuri, (King’s College University Hospital and the National Parkinson Foundation International Centre of Excellence, London) heard presentations from the expert speaker panel; Tove Henriksen (Denmark), Angelo Antonini (Italy) and Eduardo Tolosa (Spain). Tove Henriksen (University Hospital of Bispebjerg, Copenhagen) provided an overview of the evidence to support earlier intervention with CDS therapy in advanced PD patients. Factors including the psychosocial impact of PD on patients, better quality of life (QoL) through the improved control of motor symptoms in advancing disease and the potential improvement of non-motor symptoms (NMS) were all discussed, with Dr Henriksen concluding that, while the existing evidence shows that CDS therapies improve quality of life and motor function,(2) further studies are required, particularly looking at non-motor symptoms and health economic aspects. Listening to the evidence presented at the symposium,1 72% of the audience agreed when questioned that specific NMS should be taken into account when considering the optimum time to initiate CDS therapy. A lively debate between Angelo Antonini (University of Padua, Italy) and Eduardo Tolosa, (Hospital Clinic Universitari, Barcelona, Spain) discussed the motion ‘Earlier intervention than present with CDS is warranted’. Professor Antonini noted: “The issue is not just that we should do it sooner but that we should also do it better, to improve patients’ quality of life.” CDS therapy should be started earlier, prior to the fluctuations and increase in ‘off’ periods that occur in advanced disease, taking advantage of the ‘honeymoon period’. Professor Tolosa agreed that therapies used in CDS-based treatment strategies - continuous subcutaneous apomorphine infusion (CSAI), deep brain stimulation (DBS) and levodopa carbidopa intestinal gel (LCIG) - provide a dramatic improvement in reversing fluctuations and dyskinesias in complicated patients. While studies such as that published in 2011 by Pablo Martinez-Martin(3) and colleagues in Madrid show that CDS with subcutaneous apomorphine infusion led to significant improvements in non-motor symptoms, Professor Tolosa also believes that further trials are needed to support the use of these advanced therapies in patients with mild disease.
References
1. Is earlier initiation of continuous dopaminergic stimulation (CDS) therapy beneficial in advanced Parkinson’s disease? Symposium (with debate) held at the 16th Congress of the European Federation of Neurological Sciences, Stockholm, Sweden, 8-11 September 2012, chaired by P Odin and KR Chaudhuri.
2. Winter Y, von Campenhausen S, Reese JP et al. Quality of life in Parkinson's disease in Europe: a multi-centre study of the EuroPa Study Group. MDS Abstract of the 16th International Congress of Parkinson's Disease and Movement, Disorders, Dublin, Ireland, 2012. Mov Disord 2012; 27:abstract 945.
3. Martinez-Martin P, Reddy P, Antonini A et al. Chronic subcutaneous infusion therapy with apomorphine in advanced Parkinson’s disease compared to conventional therapy: a real-life study of non-motor effect. J Parkinson’s Dis 2011;1:197-203.