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Dean MN, Standaert DG. Levodopa infusion therapies for Parkinson disease. Curr Opin Neurol 2024; 37:409-413. [PMID: 38780079 DOI: 10.1097/wco.0000000000001277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
PURPOSE OF REVIEW to review recent progress in the development and use of continuous levodopa therapies in Parkinson disease (PD). RECENT FINDINGS Levodopa/Carbidopa intestinal gel (LCIG) is a continuous levodopa therapy which is widely used in the United States, Europe and other countries and is effective at reducing 'off' time. Recent work has shown that LCIG can be useful in managing dyskinesias and can improve nonmotor symptoms and quality of life. Several studies have shown good long-term effectiveness of LCIG. Recent data support the cost-effectiveness of this treatment strategy. Subcutaneous (SC) delivery of levodopa is a newer strategy that avoids the need for a surgically placed gastric tube. Two different products enabling SC delivery of levodopa are in development: ND0612 and foslevodopa/foscarbidopa. Both have recently been shown to reduce 'off' time in randomized, double-blind trials. Adverse effects of SC levodopa are primarily related to skin reactions at the infusion site. SUMMARY Continuous levodopa therapies can be used to treat Parkinson disease motor fluctuations that cannot be managed with standard oral therapies. They may also improve nonmotor symptoms, and improve overall quality of life in patients with advanced PD.
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Affiliation(s)
- Marissa N Dean
- Department of Neurology, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
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2
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Rožanković PB, Johansson A, Péter K, Milanov I, Odin P. Monotherapy with infusion therapies - useful or not? J Neural Transm (Vienna) 2024:10.1007/s00702-024-02801-2. [PMID: 38967810 DOI: 10.1007/s00702-024-02801-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Accepted: 06/24/2024] [Indexed: 07/06/2024]
Abstract
Infusion pump-based therapies are an effective treatment option for patients with advanced Parkinson´s disease. Achieving monotherapy with infusion-based therapies could simplify the treatment regimen, provide better medication adherence, reduce adverse events and drug interactions. This review presents the literature data on the efficacy, safety, and achievability of monotherapy with all available infusion-based therapies, including apomorphine, levodopa-carbidopa-intestinal gel (LCIG), levodopa-entacapone-carbidopa intestinal gel (LECIG), and foslevodopa-foscarbidopa (LDp/CDp). In summary, monotherapy is achievable and effective in most patients on intestinal levodopa infusion therapy and in some patients on apomorphine infusion. There is a need for further investigation of monotherapy compared to polytherapy, especially in new pump treatment options (LECIG and LDp/CDp). Future research should reveal which patients on infusion-based therapies could benefit from monotherapy, including identification of potential baseline predictors of achieving monotherapy in patients treated with specific infusion-based therapies.
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Affiliation(s)
- Petra Bago Rožanković
- Department of Neurology, Clinical Hospital Dubrava, Avenija Gojka Šuška 6, Zagreb, 10000, Croatia.
- School of Medicine, Catholic University of Croatia, Ilica 242, Zagreb, 10000, Croatia.
| | - Anders Johansson
- Medical Unit Neurology, Karolinska University Hospital, Stockholm, Sweden
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Klivényi Péter
- Department of Neurology, Albert Szent-Gyorgyi Medical School, University of Szeged, Szeged, Hungary
| | - Ivan Milanov
- Department of Neurology, Medical University of Sofia, Sofia, Bulgaria
| | - Per Odin
- Division of Neurology, Department of Clinical Sciences, Lund University, Lund, Sweden
- Department of Neurology, Rehabilitation medicine, Memory and Geriatrics, Skane University Hospital, Lund, Sweden
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Vekhande C, Hamed M, Tremain G, Mah J, Shetty A, Lazarescu A, Suchowersky O. Levodopa-Carbidopa Intestinal Gel for Parkinson's Disease over 11 years: One Center's "Real-World" Experience. Can J Neurol Sci 2024; 51:379-386. [PMID: 37462070 DOI: 10.1017/cjn.2023.251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/26/2023]
Abstract
BACKGROUND Levodopa-carbidopa intestinal gel (LCIG) therapy has been shown to be a safe and effective treatment for advanced Parkinson's disease (PD). Limited data are available regarding long-term benefits and complications in Canada. Objective of the study was to review long-term experience and clinical outcomes in PD patients with LCIG therapy over 11 years in a multidisciplinary University clinic setting. METHODS Chart review was done on PD patients with LCIG from 2011 to 2022. Data collected: dosing, UPDRS-III motor scores, OFF times, hours with dyskinesias, MoCA, complications, discontinuation reasons, and nursing time requirements. RESULTS Thirty-three patients received LCIG therapy with a mean follow-up of 3.25±2.09 years. UPDRS-III scores showed reduction of 15% from baseline (mean 35.9) up to 4 years (mean 30.4). Daily OFF time improved from baseline (mean 7.1 ± 3.13 hours) up to 5 years (mean 3.3 ± 2.31 hours; -53.5%; p < 0.048), and dyskinesias remained stable. Nursing time averaged 22 hours per patient per year after PEG-J insertion and titration. Most common complications were PEG-J tube dislodgement and stoma site infection (0-3zero to three events/patient/year). Serious side effects were seen in four (12%) patients resulting in hospitalization and/or death. Nine patients (27.2%) discontinued the treatment due to lack of improved efficacy over oral therapy or development of dementia and 10 (30%) died of causes unrelated to LCIG infusion. CONCLUSION Patients on LCIG showed improved motor function over 5-year follow-up. Serious complications were uncommon. Dedicated nursing time is required by LCIG-trained nurses in a multidisciplinary setting for optimum management.
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Affiliation(s)
- Chetan Vekhande
- Department of Medicine (Neurology), Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Moath Hamed
- Department of Neuroscience, NYP Brooklyn, Methodist Hospital, New York, NY, USA
| | - Genise Tremain
- Movement Disorders Program, Kaye Edmonton Clinic, Alberta Heath Services, Edmonton, AB, Canada
| | - Jennifer Mah
- Movement Disorders Program, Kaye Edmonton Clinic, Alberta Heath Services, Edmonton, AB, Canada
| | - Aakash Shetty
- Department of Medicine (Neurology), Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Adriana Lazarescu
- Department of Medicine (Gastroenterology), Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Oksana Suchowersky
- Department of Medicine (Neurology), Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
- Movement Disorders Program, Kaye Edmonton Clinic, Alberta Heath Services, Edmonton, AB, Canada
- Department of Pediatrics, Psychiatry and Medical Genetics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
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Balestrino R, Martone T, Toffoli M, Montanaro E, Fabbri M, Artusi CA, Romagnolo A, Zibetti M, Rizzone M, Goldwurm S, Lopiano L, Schapira AHV. Levodopa-carbidopa intestinal gel infusion (LCIG) in Parkinson disease with genetic mutations. Neurol Sci 2024; 45:1489-1497. [PMID: 37926749 DOI: 10.1007/s10072-023-07173-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 10/30/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND Levodopa-carbidopa intestinal gel infusion (LCIG) is a therapeutic option for advanced Parkinson disease (PD) patients with troublesome motor complications, unresponsive to conventional oral treatment. There is some evidence to suggest that the genetic background may influence the clinical presentation and rate of progression of PD. Whether the genetic background influences the outcome of device-assisted therapies is currently debated. Some studies have investigated the effectiveness of deep brain stimulation (DBS) in PD patients with different genetic background, while evidence is lacking regarding LCIG. METHODS A cohort of LCIG patients underwent genetic testing. The motor and neuropsychological outcomes of LCIG were retrospectively analyzed. RESULTS Fifty-six patients were analyzed, nine of them (15%) had at least one mutation/variant in a PD-associated gene: five GBA1, two SNCA, one LRRK2, one PRKN; 13 (23%) carried the BDNF Val66Met polymorphism. The mean duration of follow-up was 4.9 ± 2.6 years. There were no significant differences in motor or neuropsychological outcomes between patients with and without these gene mutations/variants. No cognitive worsening was observed at follow-up among GBA-PD patients, and they responded well to LCIG in terms of motor symptoms. CONCLUSIONS Overall, we observed a significant benefit in terms of motor complications in our cohort, including patients carrying genetic mutations/variants. Due to the small sample and limited number of patients carrying genetic mutations/variants, no definitive conclusions can be drawn yet on the genotype impact on LCIG outcome. A careful selection of patients, regardless of the genetic background, is pivotal for an optimal outcome of LCIG.
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Affiliation(s)
- R Balestrino
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy.
- Neurology 2 Unit, A.O.U., Città Della Salute E Della Scienza Di Torino, Corso Bramante 88, 10124, Turin, Italy.
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London, UK.
- Department of Neurosurgery and Gamma Knife Radiosurgery, IRCCS San Raffaele Scientific Institute, Milan, Italy.
- Neurology and Neurorehabiliation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
- Vita-Salute San Raffaele University, Milan, Italy.
| | - T Martone
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy
| | - M Toffoli
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London, UK
| | - E Montanaro
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy
- Neurology 2 Unit, A.O.U., Città Della Salute E Della Scienza Di Torino, Corso Bramante 88, 10124, Turin, Italy
| | - M Fabbri
- Department of Neurosciences, Clinical Investigation Center 1436, NS-Park/FCRIN Network and NeuroToul COEN Center, Toulouse University Hospital, INSERM, University of Toulouse 3, Parkinson Toulouse Expert Center, Toulouse, France
| | - C A Artusi
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy
- Neurology 2 Unit, A.O.U., Città Della Salute E Della Scienza Di Torino, Corso Bramante 88, 10124, Turin, Italy
| | - A Romagnolo
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy
- Neurology 2 Unit, A.O.U., Città Della Salute E Della Scienza Di Torino, Corso Bramante 88, 10124, Turin, Italy
| | - M Zibetti
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy
- Neurology 2 Unit, A.O.U., Città Della Salute E Della Scienza Di Torino, Corso Bramante 88, 10124, Turin, Italy
| | - M Rizzone
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy
- Neurology 2 Unit, A.O.U., Città Della Salute E Della Scienza Di Torino, Corso Bramante 88, 10124, Turin, Italy
| | - S Goldwurm
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy
| | - L Lopiano
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy
- Neurology 2 Unit, A.O.U., Città Della Salute E Della Scienza Di Torino, Corso Bramante 88, 10124, Turin, Italy
| | - A H V Schapira
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London, UK
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Aamodt WW, Kluger BM, Mirham M, Job A, Lettenberger SE, Mosley PE, Seshadri S. Caregiver Burden in Parkinson Disease: A Scoping Review of the Literature from 2017-2022. J Geriatr Psychiatry Neurol 2024; 37:96-113. [PMID: 37551798 PMCID: PMC10802092 DOI: 10.1177/08919887231195219] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/09/2023]
Abstract
Caregiver burden is a term that refers to the adverse effect of caregiving on the physical, emotional, social, spiritual, and financial well-being of the caregiver. Caregiver burden is associated with providing care to an individual with a chronic illness or disability, and the unique symptoms of Parkinson disease (PD) can amplify a patient's needs and reliance on others, leading to adverse outcomes for patients and their caregivers. In this scoping review of the literature from January 2017 through April 2022 that included 114 studies, we provide an updated, evidence-based summary of patient and caregiver-related factors that contribute to caregiver burden in PD. We also describe the impact of caregiver stress and burden on caregivers based on qualitative research studies and review recent interventions to mitigate burden. By providing clinical updates for practitioners, this review is designed to improve recognition of caregiver burden in the post-pandemic era and foster the development of targeted interventions to reduce caregiver burden in PD.
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Affiliation(s)
- Whitley W. Aamodt
- Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA
- Translational Center of Excellence for Neuroepidemiology and Neurology Outcomes Research, University of Pennsylvania, Philadelphia, PA, USA
| | - Benzi M. Kluger
- Department of Neurology, University of Rochester, Rochester, NY, USA
| | - Miray Mirham
- School of Medicine, University of Rochester, Rochester, NY, USA
| | - Anna Job
- University of Rochester, Rochester, NY, USA
| | | | - Philip E. Mosley
- School of Medicine, University of Queensland, Herston, QLD, Australia
| | - Sandhya Seshadri
- Department of Neurology, University of Rochester, Rochester, NY, USA
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Imbalzano G, Artusi CA, Ledda C, Montanaro E, Romagnolo A, Rizzone MG, Bozzali M, Lopiano L, Zibetti M. Effects of Continuous Dopaminergic Stimulation on Parkinson's Disease Gait: A Longitudinal Prospective Study with Levodopa Intestinal Gel Infusion. JOURNAL OF PARKINSON'S DISEASE 2024; 14:843-853. [PMID: 38728203 PMCID: PMC11191481 DOI: 10.3233/jpd-240003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/27/2024] [Indexed: 05/12/2024]
Abstract
Background Gait issues, including reduced speed, stride length and freezing of gait (FoG), are disabling in advanced phases of Parkinson's disease (PD), and their treatment is challenging. Levodopa/carbidopa intestinal gel (LCIG) can improve these symptoms in PD patients with suboptimal control of motor fluctuations, but it is unclear if continuous dopaminergic stimulation can further improve gait issues, independently from reducing Off-time. Objective To analyze before (T0) and after 3 (T1) and 6 (T2) months of LCIG initiation: a) the objective improvement of gait and balance; b) the improvement of FoG severity; c) the improvement of motor complications and their correlation with changes in gait parameters and FoG severity. Methods This prospective, longitudinal 6-months study analyzed quantitative gait parameters using wearable inertial sensors, FoG with the New Freezing of Gait Questionnaire (NFoG-Q), and motor complications, as per the MDS-UPDRS part IV scores. Results Gait speed and stride length increased and duration of Timed up and Go and of sit-to-stand transition was significantly reduced comparing T0 with T2, but not between T0-T1. NFoG-Q score decreased significantly from 19.3±4.6 (T0) to 11.8±7.9 (T1) and 8.4±7.6 (T2) (T1-T0 p = 0.018; T2-T0 p < 0.001). Improvement of MDS-UPDRS-IV (T0-T2, p = 0.002, T0-T1 p = 0.024) was not correlated with improvement of gait parameters and NFoG-Q from T0 to T2. LEDD did not change significantly after LCIG initiation. Conclusion Continuous dopaminergic stimulation provided by LCIG infusion progressively ameliorates gait and alleviates FoG in PD patients over time, independently from improvement of motor fluctuations and without increase of daily dosage of dopaminergic therapy.
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Affiliation(s)
- Gabriele Imbalzano
- Department of Neuroscience “Rita Levi Montalcini”, University of Torino, Torino, Italy
- SC Neurologia 2U, AOU Città della Salute e della Scienza, Torino, Italy
| | - Carlo Alberto Artusi
- Department of Neuroscience “Rita Levi Montalcini”, University of Torino, Torino, Italy
- SC Neurologia 2U, AOU Città della Salute e della Scienza, Torino, Italy
| | - Claudia Ledda
- Department of Neuroscience “Rita Levi Montalcini”, University of Torino, Torino, Italy
- SC Neurologia 2U, AOU Città della Salute e della Scienza, Torino, Italy
| | - Elisa Montanaro
- SC Neurologia 2U, AOU Città della Salute e della Scienza, Torino, Italy
| | - Alberto Romagnolo
- Department of Neuroscience “Rita Levi Montalcini”, University of Torino, Torino, Italy
- SC Neurologia 2U, AOU Città della Salute e della Scienza, Torino, Italy
| | - Mario Giorgio Rizzone
- Department of Neuroscience “Rita Levi Montalcini”, University of Torino, Torino, Italy
- SC Neurologia 2U, AOU Città della Salute e della Scienza, Torino, Italy
| | - Marco Bozzali
- Department of Neuroscience “Rita Levi Montalcini”, University of Torino, Torino, Italy
- SC Neurologia 2U, AOU Città della Salute e della Scienza, Torino, Italy
| | - Leonardo Lopiano
- Department of Neuroscience “Rita Levi Montalcini”, University of Torino, Torino, Italy
- SC Neurologia 2U, AOU Città della Salute e della Scienza, Torino, Italy
| | - Maurizio Zibetti
- Department of Neuroscience “Rita Levi Montalcini”, University of Torino, Torino, Italy
- SC Neurologia 2U, AOU Città della Salute e della Scienza, Torino, Italy
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Pahwa R, Merola A, Soileau M, Alobaidi A, Pickard AS, Kandukuri PL, Bao Y, Strezewski J, Oddsdottir J, Xu W, Standaert D. Cost-Effectiveness of Carbidopa-Levodopa Enteral Suspension for Advanced Parkinson's Disease in the United States. Mov Disord 2023; 38:2308-2312. [PMID: 37877478 DOI: 10.1002/mds.29624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 08/22/2023] [Accepted: 09/18/2023] [Indexed: 10/26/2023] Open
Abstract
BACKGROUND Carbidopa/levodopa enteral suspension (CLES) is indicated for the treatment of advanced Parkinson's disease (aPD) with severe motor fluctuations. OBJECTIVE To determine the cost, quality-adjusted life years (QALY), and cost-effectiveness of CLES compared to the standard-of-care (SoC) for aPD patients in the United States (US), using real-world data. METHODS A published Markov model, comprising of 25 health states and a death state, (defined by a combination of the Hoehn and Yahr scale and waking time spent in OFF-time) was adapted to estimate the benefits for CLES versus oral SoC over a patient's lifetime in the US healthcare setting. Clinical inputs were based on a clinical trial and a registry study; utility inputs were sourced from the Adelphi-Disease Specific Programmes. RESULTS CLES compared to SoC was associated with incremental costs ($1,031,791 vs. $1,025,180) and QALY gain (4.61 vs. 3.76), resulting in an incremental cost-effectiveness ratio of $7711/QALY. CONCLUSION CLES is a cost-effective treatment for aPD patients with medication resistant motor fluctuations. © 2023 AbbVie, Inc and The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Rajesh Pahwa
- University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Aristide Merola
- Ohio State University, Wexner Medical Center, Columbus, Ohio, USA
| | | | | | | | | | - Yanjun Bao
- AbbVie Inc., North Chicago, Illinois, USA
| | | | | | | | - David Standaert
- Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Tall P, Qamar MA, Batzu L, Leta V, Falup-Pecurariu C, Ray Chaudhuri K. Non-oral continuous drug delivery based therapies and sleep dysfunction in Parkinson's disease. J Neural Transm (Vienna) 2023; 130:1443-1449. [PMID: 37126118 PMCID: PMC10645607 DOI: 10.1007/s00702-023-02640-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 04/21/2023] [Indexed: 05/02/2023]
Abstract
Continuous drug delivery (CDD) has emerged as a feasible and pragmatic therapeutic option for dopamine replacement therapy in advanced Parkinson's disease (PD). CDD aims to mimic the physiological tonic dopamine release from striatal dopaminergic neurons and thus reduces the severity and duration of motor and non-motor fluctuations partly related to pulsatile levodopa stimulation. Non-motor symptoms and fluctuations are ubiquitous in PD and include sleep dysfunction, a problem that occurs in over 90% of PD patients across all stages, from prodromal to palliative. In this review, we discuss the currently available and in development non-oral dopaminergic CDD strategies with a focus on their efficacy in the treatment of the burdensome sleep dysfunction in PD.
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Affiliation(s)
- P Tall
- Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AB, UK.
- Parkinson's Foundation Centre of Excellence, King's College Hospital, London, UK.
| | - M A Qamar
- Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AB, UK.
- Parkinson's Foundation Centre of Excellence, King's College Hospital, London, UK.
| | - L Batzu
- Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AB, UK
- Parkinson's Foundation Centre of Excellence, King's College Hospital, London, UK
| | - V Leta
- Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AB, UK
- Parkinson's Foundation Centre of Excellence, King's College Hospital, London, UK
| | - C Falup-Pecurariu
- Faculty of Medicine, Transilvania University, Brasov, Romania
- Department of Neurology, County Clinic Hospital, Brasov, Romania
| | - K Ray Chaudhuri
- Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AB, UK
- Parkinson's Foundation Centre of Excellence, King's College Hospital, London, UK
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9
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Antonini A, D'Onofrio V, Guerra A. Current and novel infusion therapies for patients with Parkinson's disease. J Neural Transm (Vienna) 2023; 130:1349-1358. [PMID: 37672049 PMCID: PMC10645652 DOI: 10.1007/s00702-023-02693-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 08/24/2023] [Indexed: 09/07/2023]
Abstract
Advanced Parkinson's disease is characterized by periods of poor mobility, dyskinesia and progressive decline in functional independence of the affected person despite the manipulation of levodopa doses and the introduction of supplemental therapies such as catechol-O-methyl transferase inhibitors, monoamine oxidase-B inhibitors and dopamine agonists. The implementation of drug delivery systems allows to bypass problems related to irregular and often unpredictable intestinal absorption of oral levodopa, which significantly affects its bioavailability and contributes to the development and persistence of motor complications. Subcutaneous apomorphine and levodopa/carbidopa jejunal infusion systems have been available for many years and their efficacy is confirmed by randomized studies and long-term experience in many centers worldwide. Recently, a new formulation of levodopa/carbidopa infusion gel that includes the catechol-O-methyl transferase inhibitor Entacapone has been introduced to the market. The use of entacapone allows to reduce total daily dose of administered levodopa. Two different soluble formulations of levodopa/carbidopa (ND0612 and ABBV-951) have completed clinical development, and both can ensure subcutaneous delivery by a portable pump infusion system. ABBV-951 uses a foslevodopa/foscarbidopa formulation, both prodrugs to improve absorption and tolerability. Both systems provide effective improvement of motor complications and are likely to expand the therapeutic options in advanced patients. Future efforts should focus on the earlier detection of patients who are candidates for device-aided therapies, increasing appropriate referral and broadening the availability of these treatments globally.
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Affiliation(s)
- Angelo Antonini
- Parkinson and Movement Disorders Unit, Centre for Rare Neurological Diseases (ERN-RND), Department of Neuroscience, University of Padua, Via Giustiniani 3, 35121, Padua, Italy.
- Padova Neuroscience Center (PNC), University of Padua, Padua, Italy.
| | | | - Andrea Guerra
- Parkinson and Movement Disorders Unit, Centre for Rare Neurological Diseases (ERN-RND), Department of Neuroscience, University of Padua, Via Giustiniani 3, 35121, Padua, Italy
- Padova Neuroscience Center (PNC), University of Padua, Padua, Italy
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10
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Constantin VA, Szász JA, Dulamea AO, Valkovic P, Kulisevsky J. Impact of Infusion Therapies on Quality of Life in Advanced Parkinson's Disease. Neuropsychiatr Dis Treat 2023; 19:1959-1972. [PMID: 37727253 PMCID: PMC10506606 DOI: 10.2147/ndt.s422717] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 09/01/2023] [Indexed: 09/21/2023] Open
Abstract
A high burden of motor and non-motor parkinsonian symptoms is known to have a significant negative impact on the quality of life (QoL) of people with Parkinson's disease (PD). Effective control of these symptoms with therapies that enable patients to maintain a good QoL is therefore a key treatment goal in PD management. When symptom control can no longer be accomplished with oral or transdermal PD treatment regimens, device-aided therapies (DAT), namely levodopa and apomorphine infusion therapies, and deep brain stimulation, are valuable options to consider. DAT options may also help reduce pill burden and thereby improve compliance with treatment. Since PD therapy relies on symptomatic management, the efficacy and tolerability of any intervention is undoubtedly important, however the impact of different therapies on patient-related outcome measures, in particular health-related QoL, is also a critical consideration for those living with a chronic and disabling condition. This review discusses clinical evidence and ongoing research regarding the QoL benefits of levodopa and apomorphine infusion therapies from studies that have used validated QoL outcome measures. The data suggest that timing of these interventions is important to achieve optimal treatment effects, and that early initiation onto infusion therapies at the point when motor fluctuations emerge, and before patient QoL and functioning have significantly declined, may provide the best long-term outcomes. Healthcare professionals caring for people with PD should therefore discuss all available DAT options with them at an early stage in the course of their disease so they can make informed and timely choices that best suit them, their families and care network.
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Affiliation(s)
- Viorelia A Constantin
- Second Clinic of Neurology, Târgu Mures County Emergency Clinical Hospital, Târgu Mureș, Romania
| | - József A Szász
- Second Clinic of Neurology, Târgu Mures County Emergency Clinical Hospital, Târgu Mureș, Romania
- Department of Neurology, George Emil Palade University of Medicine, Pharmacy, Science and Technology, Târgu Mureș, Romania
| | - Adriana Octaviana Dulamea
- Neurology Clinic, Fundeni Clinical Institute, Bucharest, Romania
- University of Medicine and Pharmacy “Carol Davila” Bucharest, Bucharest, Romania
| | - Peter Valkovic
- Second Department of Neurology, Comenius University Faculty of Medicine and University Hospital Bratislava, Bratislava, Slovakia
| | - Jaime Kulisevsky
- Movement Disorders Unit at the Neurology Department of Sant Pau Hospital, Barcelona, Spain
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Tall P, Qamar MA, Rosenzweig I, Raeder V, Sauerbier A, Heidemarie Z, Falup-Pecurariu C, Chaudhuri KR. The Park Sleep subtype in Parkinson's disease: from concept to clinic. Expert Opin Pharmacother 2023; 24:1725-1736. [PMID: 37561080 DOI: 10.1080/14656566.2023.2242786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 07/27/2023] [Indexed: 08/11/2023]
Abstract
INTRODUCTION The heterogeneity of Parkinson's disease (PD) is evident from descriptions of non-motor (NMS) subtypes and Park Sleep, originally identified by Sauerbier et al. 2016, is one such clinical subtype associated with the predominant clinical presentation of sleep dysfunctions including excessive daytime sleepiness (EDS), along with insomnia. AREAS COVERED A literature search was conducted using the PubMed, Medline, Embase, and Web of Science databases, accessed between 1 February 2023 and 28 March 2023. In this review, we describe the clinical subtype of Park Sleep and related 'tests' ranging from polysomnography to investigational neuromelanin MRI brain scans and some tissue-based biological markers. EXPERT OPINION Cholinergic, noradrenergic, and serotonergic systems are dominantly affected in PD. Park Sleep subtype is hypothesized to be associated primarily with serotonergic deficit, clinically manifesting as somnolence and narcoleptic events (sleep attacks), with or without rapid eye movement behavior disorder (RBD). In clinic, Park Sleep recognition may drive lifestyle changes (e.g. driving) along with therapy adjustments as Park Sleep patients may be sensitive to dopamine D3 active agonists, such as ropinirole and pramipexole. Specific dashboard scores based personalized management options need to be implemented and include pharmacological, non-pharmacological, and lifestyle linked advice.
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Affiliation(s)
- Phoebe Tall
- Department of Neuroscience, Institute of Psychiatry, Psychology, and Neuroscience (IoPpn), King's College London, London, UK
- Parkinson's Foundation Centre of Excellence, King's College Hospital NHS Foundation Trust, London, UK
| | - Mubasher A Qamar
- Department of Neuroscience, Institute of Psychiatry, Psychology, and Neuroscience (IoPpn), King's College London, London, UK
- Parkinson's Foundation Centre of Excellence, King's College Hospital NHS Foundation Trust, London, UK
| | - Ivana Rosenzweig
- Sleep and Brain Plasticity Centre, Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience (IoPpn), King's College London, London, UK
- Sleep Disorder Centre, Nuffield House, Guy's Hospital, London, UK
| | - Vanessa Raeder
- Parkinson's Foundation Centre of Excellence, King's College Hospital NHS Foundation Trust, London, UK
- Department of Neurology and Experimental Neurology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität, Berlin, Germany
| | - Anna Sauerbier
- Department of Neuroscience, Institute of Psychiatry, Psychology, and Neuroscience (IoPpn), King's College London, London, UK
- Department of Neurology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Zach Heidemarie
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Cristian Falup-Pecurariu
- Faculty of Medicine, Transilvania University of Braşov, Brașov, Romania
- Department of Neurology, County Clinic Hospital, Braşov, Romania
| | - Kallol Ray Chaudhuri
- Department of Neuroscience, Institute of Psychiatry, Psychology, and Neuroscience (IoPpn), King's College London, London, UK
- Parkinson's Foundation Centre of Excellence, King's College Hospital NHS Foundation Trust, London, UK
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12
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Morales-Briceño H, Ha AD, Chiang HL, Tai Y, Chang FCF, Tsui DS, Griffith J, Galea D, Kim SD, Cruse B, Mahant N, Fung VSC. A single centre prospective study of three device-assisted therapies for Parkinson's disease. NPJ Parkinsons Dis 2023; 9:101. [PMID: 37386050 DOI: 10.1038/s41531-023-00525-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 05/15/2023] [Indexed: 07/01/2023] Open
Abstract
Comparative studies assessing outcomes with the three device-assisted therapies could help to individualise treatment for patients living with Parkinson's disease. We designed a single-centre non-randomised prospective observational study assessing the quality of life (QoL), motor and non-motor outcomes at 6 and 12-months in patients treated with subcutaneous apomorphine continuous 16-hours infusion (APO), levodopa-carbidopa intestinal gel (LCIG) or subthalamic nucleus deep brain stimulation (STN-DBS). In this study, 66 patients were included (13 APO; 19 LCIG; 34 STN-DBS). At baseline, cognitive, non-motor and motor scores were significantly less severe in the STN-DBS group, whereas the LCIG group had a longer disease duration and higher non-motor scores. In the APO group, there were no statistically significant changes in non-motor, motor and QoL scales. The LCIG group had significant changes in QoL and motor scales that were significant after multiple comparison analysis at 6 and 12-months. The STN-DBS group showed improvement in QoL scores and non-motor and motor scores at 6 and 12-months after multiple comparison analysis. In this real-life prospective study, device-assisted therapies showed differences in their effects on QoL and motor and non-motor function at 12-months. However, there were also differences in baseline characteristics of the patient groups that were not based on pre-determined selection criteria. Differences in characteristics of patients offered and/or treatment with different device-assisted therapies may reflect within-centre biases that may, in turn, influence perceptions of treatment efficacy or outcomes. Treatment centres should be aware of this potential confounder when assessing and offering device-assisted treatment options to their patients and potential baseline differences need to be taken into consideration when comparing the results of non-randomised studies.
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Affiliation(s)
- Hugo Morales-Briceño
- Movement Disorders Unit, Neurology Department, Westmead Hospital, Westmead, NSW, 2145, Australia
- Sydney Medical School, University of Sydney, Sydney, NSW, 2145, Australia
| | - Ainhi D Ha
- Movement Disorders Unit, Neurology Department, Westmead Hospital, Westmead, NSW, 2145, Australia
- Sydney Medical School, University of Sydney, Sydney, NSW, 2145, Australia
| | - Han-Lin Chiang
- Movement Disorders Unit, Neurology Department, Westmead Hospital, Westmead, NSW, 2145, Australia
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei City, Taiwan
| | - Yicheng Tai
- Movement Disorders Unit, Neurology Department, Westmead Hospital, Westmead, NSW, 2145, Australia
- Department of Neurology, E-DA Hospital/I-Shou University, No.1, Yida Rd., Yanchao Dist., Kaohsiung City, 824, Taiwan
| | - Florence C F Chang
- Movement Disorders Unit, Neurology Department, Westmead Hospital, Westmead, NSW, 2145, Australia
- Sydney Medical School, University of Sydney, Sydney, NSW, 2145, Australia
| | - David S Tsui
- Movement Disorders Unit, Neurology Department, Westmead Hospital, Westmead, NSW, 2145, Australia
| | - Jane Griffith
- Movement Disorders Unit, Neurology Department, Westmead Hospital, Westmead, NSW, 2145, Australia
| | - Donna Galea
- Movement Disorders Unit, Neurology Department, Westmead Hospital, Westmead, NSW, 2145, Australia
| | - Samuel D Kim
- Movement Disorders Unit, Neurology Department, Westmead Hospital, Westmead, NSW, 2145, Australia
- Sydney Medical School, University of Sydney, Sydney, NSW, 2145, Australia
| | - Belinda Cruse
- Movement Disorders Unit, Neurology Department, Westmead Hospital, Westmead, NSW, 2145, Australia
| | - Neil Mahant
- Movement Disorders Unit, Neurology Department, Westmead Hospital, Westmead, NSW, 2145, Australia
- Sydney Medical School, University of Sydney, Sydney, NSW, 2145, Australia
| | - Victor S C Fung
- Movement Disorders Unit, Neurology Department, Westmead Hospital, Westmead, NSW, 2145, Australia.
- Sydney Medical School, University of Sydney, Sydney, NSW, 2145, Australia.
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13
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Rinaldi D, Galli S, Fanciulli A, Pontieri FE. Levodopa/carbidopa intestinal gel via percutaneous endoscopic transgastric jejunostomy in advanced Parkinson's disease: hitting two birds with one stone? Parkinsonism Relat Disord 2023:105394. [PMID: 37076400 DOI: 10.1016/j.parkreldis.2023.105394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 03/26/2023] [Accepted: 04/02/2023] [Indexed: 04/21/2023]
Abstract
Here we focus on people with advanced PD undergoing percutaneous endoscopic transgastric jejunostomy (PEG-J) ("one stone") for LCIG infusion therapy for managing severe motor fluctuations ("first bird") and discuss its implications for improving accompanying symptoms of cardiovascular, urinary, and gastrointestinal autonomic failure ("second bird").
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Affiliation(s)
- Domiziana Rinaldi
- Dipartimento di Neuroscienze, Salute Mentale e Organi di Senso - NESMOS, Sapienza University of Rome, Rome, Italy; Fondazione Santa Lucia, IRCCS, Rome, Italy
| | - Silvia Galli
- Dipartimento di Neuroscienze, Salute Mentale e Organi di Senso - NESMOS, Sapienza University of Rome, Rome, Italy
| | | | - Francesco E Pontieri
- Dipartimento di Neuroscienze, Salute Mentale e Organi di Senso - NESMOS, Sapienza University of Rome, Rome, Italy; Fondazione Santa Lucia, IRCCS, Rome, Italy
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Martinez-Martin P, Skorvanek M, Henriksen T, Lindvall S, Domingos J, Alobaidi A, Kandukuri PL, Chaudhari VS, Patel AB, Parra JC, Pike J, Antonini A. Impact of advanced Parkinson's disease on caregivers: an international real-world study. J Neurol 2023; 270:2162-2173. [PMID: 36633671 PMCID: PMC9835744 DOI: 10.1007/s00415-022-11546-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 11/25/2022] [Accepted: 12/22/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND Caring for a partner or family member with Parkinson's disease (PD) negatively affects the caregiver's own physical and emotional well-being, especially those caring for people with advanced PD (APD). This study was designed to examine the impact of APD on caregiver perceived burden, quality of life (QoL), and health status. METHODS Dyads of people with PD and their primary caregivers were identified from the Adelphi Parkinson's Disease Specific Program (DSP™) using real-world data from the United States, Japan and five European countries. Questionnaires were used to capture measures of clinical burden (people with PD) and caregiver burden (caregivers). RESULTS Data from 721 patient-caregiver dyads in seven countries were captured. Caregivers had a mean age 62.6 years, 71.6% were female, and 70.4% were a spouse. Caregivers for people with APD had a greater perceived burden, were more likely to take medication and had lower caregiver treatment satisfaction than those caring for people with early or intermediate PD; similar findings were observed for caregivers of people with intermediate versus early PD. Caregivers for people with intermediate PD were also less likely to be employed than those with early PD (25.3% vs 42.4%) and spent more time caring (6.6 vs 3.2 h/day). CONCLUSIONS This real-world study demonstrates that caregivers of people with APD experience a greater burden than those caring for people with early PD. This highlights the importance of including caregiver-centric measures in future studies, and emphasizes the need for implementing treatments that reduce caregiver burden in APD. TRIAL REGISTRATION N/A.
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Affiliation(s)
- Pablo Martinez-Martin
- grid.413448.e0000 0000 9314 1427Center for Networked Biomedical Research, Neurodegenerative Diseases (CIBERNED), Carlos III Institute of Health, Madrid, Spain
| | - Matej Skorvanek
- grid.11175.330000 0004 0576 0391Department of Neurology, P. J. Šafárik University, Košice, Slovakia
- grid.412894.20000 0004 0619 0183Department of Neurology, University Hospital L. Pasteur, Košice, Slovakia
| | - Tove Henriksen
- grid.475435.4Movement Disorder Clinic, University Hospital of Bispebjerg, Copenhagen, Denmark
| | | | - Josefa Domingos
- European Parkinson’s Disease Association (EPDA), Sevenoaks, UK
| | - Ali Alobaidi
- grid.431072.30000 0004 0572 4227AbbVie Inc., North Chicago, IL USA
- grid.185648.60000 0001 2175 0319University of Illinois at Chicago, Chicago, IL USA
| | | | | | - Apeksha B. Patel
- grid.431072.30000 0004 0572 4227AbbVie Inc., North Chicago, IL USA
| | | | - James Pike
- Adelphi Real World, Adelphi Mill, Bollington, UK
| | - Angelo Antonini
- grid.5608.b0000 0004 1757 3470Movement Disorders Unit, Department of Neuroscience, University of Padova, Padua, Italy
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15
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Fabbri M, Barbosa R, Rascol O. Off-time Treatment Options for Parkinson's Disease. Neurol Ther 2023; 12:391-424. [PMID: 36633762 PMCID: PMC10043092 DOI: 10.1007/s40120-022-00435-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 12/20/2022] [Indexed: 01/13/2023] Open
Abstract
Motor fluctuations (MF) are deemed by patients with Parkinson's disease (PD) as the most troublesome disease feature resulting from the increasing impairment in responsiveness to dopaminergic drug treatments. MF are characterized by the loss of a stable response to levodopa over the nychthemeron with the reappearance of motor (and non-motor) parkinsonian clinical signs at various moments during the day and night. They normally appear after a few years of levodopa treatment and with a variable, though overall increasing severity, over the disease course. The armamentarium of first-line treatment options has widened in the last decade with new once-a-daily compounds, including a catechol O-methyltransferase inhibitor - Opicapone-, two MAO-B inhibitors plus channel blocker - Zonisamide and Safinamide and one amantadine extended-release formulation - ADS5012. In addition to apomorphine injection or oral levodopa dispersible tablets, which have been available for a long time, new on-demand therapies such as apomorphine sublingual or levodopa inhaled formulations have recently shown efficacy as rescue therapies for Off-time treatment. When the management of MF becomes difficult in spite of oral/on-demand options, more complex therapies should be considered, including surgical, i.e. deep brain stimulation, or device-aided therapies with pump systems delivering continuous subcutaneous or intestinal levodopa or subcutaneous apomorphine formulation. Older and less commonly used ablative techniques (radiofrequency pallidotomy) may also be effective while there is still scarce data regarding Off-time reduction using a new lesional approach, i.e. magnetic resonance-guided focused ultrasound. The choice between the different advanced therapies options is a shared decision that should consider physician opinion on contraindication/main target symptom, patients' preference, caregiver's availability together with public health systems and socio-economic environment. The choice of the right/first add-on treatment is still a matter of debate as well as the proper time for an advanced therapy to be considered. In this narrative review, we discuss all the above cited aspects of MF in patients with PD, including their phenomenology, management, by means of pharmacological and advanced therapies, on-going clinical trials and future research and treatment perspectives.
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Affiliation(s)
- Margherita Fabbri
- Department of Clinical Pharmacology and Neurosciences, Toulouse Parkinson Expert Centre, Toulouse NeuroToul Center of Excellence in Neurodegeneration (COEN), French NS-Park/F-CRIN Network, University of Toulouse 3, CHU of Toulouse, INSERM, Toulouse, France.
| | - Raquel Barbosa
- Department of Clinical Pharmacology and Neurosciences, Toulouse Parkinson Expert Centre, Toulouse NeuroToul Center of Excellence in Neurodegeneration (COEN), French NS-Park/F-CRIN Network, University of Toulouse 3, CHU of Toulouse, INSERM, Toulouse, France.,Department of Neurology, Hospital de Egas Moniz Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal.,NOVA Medical School, Faculdade de Ciências Médicas Universidade Nova de Lisboa, Lisbon, Portugal
| | - Olivier Rascol
- Department of Clinical Pharmacology and Neurosciences, Toulouse Parkinson Expert Centre, Toulouse NeuroToul Center of Excellence in Neurodegeneration (COEN), French NS-Park/F-CRIN Network, University of Toulouse 3, CHU of Toulouse, INSERM, Toulouse, France
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16
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Chaudhuri KR, Kovács N, Pontieri FE, Aldred J, Bourgeois P, Davis TL, Cubo E, Anca-Herschkovitsch M, Iansek R, Siddiqui MS, Simu M, Bergmann L, Ballina M, Kukreja P, Ladhani O, Jia J, Standaert DG. Levodopa Carbidopa Intestinal Gel in Advanced Parkinson's Disease: DUOGLOBE Final 3-Year Results. JOURNAL OF PARKINSON'S DISEASE 2023; 13:769-783. [PMID: 37302039 PMCID: PMC10473130 DOI: 10.3233/jpd-225105] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/14/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND Levodopa-carbidopa intestinal gel (LCIG) improves motor and non-motor symptoms in patients with advanced Parkinson's disease (aPD). OBJECTIVE To present the final 36-month efficacy and safety results from DUOGLOBE (DUOdopa/Duopa in Patients with Advanced Parkinson's Disease - a GLobal OBservational Study Evaluating Long-Term Effectiveness; NCT02611713). METHODS DUOGLOBE was an international, prospective, long-term, real-world, observational study of patients with aPD initiating LCIG in routine clinical care. The primary endpoint was change in patient-reported "Off" time to Month 36. Safety was assessed by monitoring serious adverse events (SAEs). RESULTS Significant improvements in "Off" time were maintained over 3 years (mean [SD]: -3.3 hours [3.7]; p < 0.001). There were significant improvements to Month 36 in total scores of the Unified Dyskinesia Rating Scale (-5.9 [23.7]; p = 0.044), Non-Motor Symptoms Scale (-14.3 [40.5]; p = 0.002), Parkinson's Disease Sleep Scale-2 (-5.8 [12.9]; p < 0.001), and Epworth Sleepiness Scale (-1.8 [6.0]; p = 0.008). Health-related quality of life and caregiver burden significantly improved through Months 24 and 30, respectively (Month 24, 8-item Parkinson's Disease Questionnaire Summary Index, -6.0 [22.5]; p = 0.006; Month 30, Modified Caregiver Strain Index, -2.3 [7.6]; p = 0.026). Safety was consistent with the well-established LCIG profile (SAEs: 54.9% of patients; discontinuations: 54.4%; discontinuations due to an adverse event: 27.2%). Of 106 study discontinuations, 32 patients (30.2%) continued LCIG outside the study. CONCLUSION DUOGLOBE demonstrates real-world, long-term, reductions in motor and non-motor symptoms in patients with aPD treated with LCIG.
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Affiliation(s)
- K. Ray Chaudhuri
- Parkinson’s Foundation International Centre of Excellence, King’s College Hospital, and King’s College Institute of Psychiatry, Biomedical Research Centre, Psychology & Neuroscience, London, United Kingdom
| | - Norbert Kovács
- Department of Neurology, University of Pécs, Pécs, Hungary
| | - Francesco E. Pontieri
- Department of Neuroscience, Mental Health and Sensory Organs, Sapienza University of Rome, Rome, Italy
- Santa Lucia Foundation, IRCCS, Rome, Italy
| | | | | | - Thomas L. Davis
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Esther Cubo
- Neurology Department, Hospital Universitario Burgos, Burgos, Spain
| | | | - Robert Iansek
- Kingston Centre, Monash Health, Melbourne, Victoria, Australia
| | - Mustafa S. Siddiqui
- Department of Neurology, Wake Forest School of Medicine, Winston Salem, NC, USA
| | - Mihaela Simu
- Department of Neurology, Victor Babes Universityof Medicine and Pharmacy, Timisoara, Romania
| | | | | | | | | | - Jia Jia
- AbbVie Inc., North Chicago, IL, USA
| | - David G. Standaert
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA
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17
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van Laar T, Chaudhuri KR, Antonini A, Henriksen T, Trošt M. Infusion Therapies in the Treatment of Parkinson's Disease. JOURNAL OF PARKINSON'S DISEASE 2023; 13:641-657. [PMID: 37334617 PMCID: PMC10473148 DOI: 10.3233/jpd-225112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/04/2023] [Indexed: 06/20/2023]
Abstract
Oral levodopa is the gold-standard therapy for treating Parkinson's disease (PD) but after a few years of treatment the therapeutic window narrows, and patients often experience various treatment-related complications. Patients in this advanced PD stage may benefit from alternative therapy, such as continuous intrajejunal delivery of levodopa-carbidopa intestinal gel (LCIG; or carbidopa-levodopa enteral suspension), continuous intrajejunal delivery of levodopa-carbidopa-entacapone intestinal gel, or continuous subcutaneous apomorphine infusion. Consideration and initiation of infusion therapies in advanced PD are suggested before the onset of major disability. The present review summarizes clinical evidence for infusion therapy in advanced PD management, discusses available screening tools for advanced PD, and provides considerations around optimal use of infusion therapy.
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Affiliation(s)
- Teus van Laar
- Department of Neurology, University Medical Center Groningen, University of Groningen, The Netherlands
| | - K. Ray Chaudhuri
- Parkinson’s Foundation International Centre of Excellence, King’s College Hospital, London, UK
- Psychology & Neuroscience, King’s College Institute of Psychiatry, London, UK
| | - Angelo Antonini
- Parkinson and Movement Disorders Unit, Study Center on Neurodegeneration (CESNE), Department of Neuroscience, Padua University, Padua, Italy
| | - Tove Henriksen
- Department of Neurology, Movement Disorder Clinic, University Hospital of Bispebjerg, Copenhagen, Denmark
| | - Maja Trošt
- Department of Neurology, University Medical Centre Ljubljana, Slovenia, Faculty of Medicine, University of Ljubljana, Slovenia
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18
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Diaconu Ş, Irincu L, Ţînţ D, Falup-Pecurariu C. Long-term effects of intrajejunal levodopa infusion on sleep in people with advanced Parkinson's disease. Front Neurol 2023; 14:1105650. [PMID: 37153671 PMCID: PMC10157066 DOI: 10.3389/fneur.2023.1105650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 03/30/2023] [Indexed: 05/10/2023] Open
Abstract
Background Sleep disturbances are commonly encountered in people with advanced Parkinson's disease (PD). In these stages, levodopa-carbidopa intestinal gel (LCIG) is recommended for improving motor symptoms, some non-motor dysfunctions, and quality of life in these patients. This study aimed to assess the effects of LCIG on sleep in PD in a longitudinal study. Study design An open-label observational study in patients with advanced PD undergoing LCIG treatment was carried out. Measures and outcomes In total, 10 consecutive advanced people with PD were evaluated at the baseline and after 6 months and 1 year, respectively, of LCIG infusion. Sleep parameters were assessed with several validated scales. We assessed the evolution of sleep parameters under LCIG infusion over time and the effects on sleep quality. Results Significant improvement following LCIG was observed in PSQI total score (p = 0.007), SCOPA-SLEEP total score (p = 0.008), SCOPA-NS subscale (p = 0.007), and AIS total score (p = 0.001) at 6 months and 1 year, compared to the baseline. The PSQI total score at 6 months correlated significantly with the Parkinson's Disease Sleep Scale, version 2 (PDSS-2) "disturbed sleep" item at 6 months (p = 0.28; R = 0.688), while the PSQI total score at 12 months significantly correlated with the PDSS-2 total score at 1 year (p = 0.025, R = 0.697) and with the AIS total score at 1 year (p = 0.015, R = 0.739). Conclusion LCIG infusion demonstrated beneficial effects on sleep parameters and sleep quality, which were constant over time for up to 12 months.
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Affiliation(s)
- Ştefania Diaconu
- County Clinic Hospital, Braşov, Romania
- Faculty of Medicine, Transilvania University, Braşov, Romania
- *Correspondence: Ştefania Diaconu
| | - Laura Irincu
- County Clinic Hospital, Braşov, Romania
- Faculty of Medicine, Transilvania University, Braşov, Romania
| | - Diana Ţînţ
- Faculty of Medicine, Transilvania University, Braşov, Romania
- Clinicco, Braşov, Romania
| | - Cristian Falup-Pecurariu
- County Clinic Hospital, Braşov, Romania
- Faculty of Medicine, Transilvania University, Braşov, Romania
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19
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Metta V, Chaudhuri KR, Leta V, Mridula KR, Koduri C, Deepak S, Kalpala R, Reddy N, Chung-Faye G, Borgohain R. Real-life benefits of intrajejunal levodopa infusion therapy in four patients with the parkinsonian variant of progressive supranuclear palsy: A 1-year follow-up data report. Brain Behav 2022; 12:e2547. [PMID: 35943202 PMCID: PMC9480946 DOI: 10.1002/brb3.2547] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 02/10/2022] [Accepted: 02/13/2022] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Progressive supranuclear palsy (PSP) is a progressive neurodegenerative condition presenting with different clinical endophenotypes. The parkinsonian variant of PSP (PSP-P) is characterised by early but fading responsiveness to high-dose levodopa therapy; however, high-dose oral therapy is often associated with intolerance due to dopaminergic side effects and so doses may have to be capped despite clinical benefits. Evidence from animal models and real-life registries suggest far higher doses of levodopa can be tolerated if given in a continuous drug delivery (CDD) manner. We investigated tolerance and possible clinical benefits in patients with PSP-P still responsive to levodopa after initiating CDD in the form of intrajejunal levodopa infusion (IJLI) therapy as part of a compassionate usage program (CU). METHODS This is an observational clinical data report from the IJLI implementation program undertaken in regional tertiary referral Parkinson's centres in India and at King's College Hospital London, Dubai as part of a CU. Four patients with PSP-P receiving IJLI as a part of a CU underwent evaluations of liver and renal function, motor and nonmotor function, quality of life, sleep dysfunction, fatigue, anxiety and depression, and cognitive impairment at baseline and 6 and 12 months post-IJLI initiation. RESULTS In total, three out of four patients successfully completed 12 months of treatment (6 months in one patient). All four patients showed good tolerability to IJLI even at higher doses (1400 and 1960 mg at 6 and 12 months, respectively) when compared to oral levodopa (812.5 ± 103 levodopa equivalent daily dose [LEDD]) and presented with overall persistent improvements in motor and nonmotor scores and quality-of-life scores at 6 and 12 months post-IJLI. All patients showed improvement in estimated glomerular filtration rate (43.50 ml/min/1.73 m2 to 67.5 ml/min/1.73 m2 and 79.5 ml/min/1.73 m2 at 6 and 12 months, respectively). CONCLUSIONS IJLI led to persistent beneficial effects on motor and some nonmotor aspects in patients with PSP-P at up to 12 months after treatment with associated improvement in overall renal function.
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Affiliation(s)
- Vinod Metta
- Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.,Parkinson's Foundation Centre of Excellence, King's College Hospital, London, UK
| | - K Ray Chaudhuri
- Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.,Parkinson's Foundation Centre of Excellence, King's College Hospital, London, UK
| | - Valentina Leta
- Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.,Parkinson's Foundation Centre of Excellence, King's College Hospital, London, UK
| | | | | | - Sai Deepak
- Asian Institute of Gastroenterology, Hyderabad, India
| | | | | | - Guy Chung-Faye
- Department of Gastroenterology, King's College Hospital, London, UK
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20
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Di Luca DG, Reyes NGD, Fox SH. Newly Approved and Investigational Drugs for Motor Symptom Control in Parkinson's Disease. Drugs 2022; 82:1027-1053. [PMID: 35841520 PMCID: PMC9287529 DOI: 10.1007/s40265-022-01747-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2022] [Indexed: 12/11/2022]
Abstract
Motor symptoms are a core feature of Parkinson’s disease (PD) and cause a significant burden on patients’ quality of life. Oral levodopa is still the most effective treatment, however, the motor benefits are countered by inherent pharmacologic limitations of the drug. Additionally, with disease progression, chronic levodopa leads to the appearance of motor complications including motor fluctuations and dyskinesia. Furthermore, several motor abnormalities of posture, balance, and gait may become less responsive to levodopa. With these unmet needs and our evolving understanding of the neuroanatomic and pathophysiologic underpinnings of PD, several advances have been made in defining new therapies for motor symptoms. These include newer levodopa formulations and drug delivery systems, refinements in adjunctive medications, and non-dopaminergic treatment strategies. Although some are in early stages of development, these novel treatments potentially widen the available options for the management of motor symptoms allowing clinicians to provide an individually tailored care for PD patients. Here, we review the existing and emerging interventions for PD with focus on newly approved and investigational drugs for motor symptoms, motor fluctuations, dyskinesia, and balance and gait dysfunction.
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Affiliation(s)
- Daniel Garbin Di Luca
- Edmond J. Safra Program in Parkinson's Disease, Movement Disorders Clinic, Krembil Brain Institute, Toronto Western Hospital, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Nikolai Gil D Reyes
- Edmond J. Safra Program in Parkinson's Disease, Movement Disorders Clinic, Krembil Brain Institute, Toronto Western Hospital, Toronto, ON, Canada
| | - Susan H Fox
- Edmond J. Safra Program in Parkinson's Disease, Movement Disorders Clinic, Krembil Brain Institute, Toronto Western Hospital, Toronto, ON, Canada.
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21
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Kovács N, Bergmann L, Anca-Herschkovitsch M, Cubo E, Davis TL, Iansek R, Siddiqui MS, Simu M, Standaert DG, Chaudhuri KR, Bourgeois P, Gao T, Kukreja P, Pontieri FE, Aldred J. Outcomes Impacting Quality of Life in Advanced Parkinson’s Disease Patients Treated with Levodopa-Carbidopa Intestinal Gel. JOURNAL OF PARKINSON'S DISEASE 2022; 12:917-926. [PMID: 34974438 PMCID: PMC9108584 DOI: 10.3233/jpd-212979] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Background: It is believed that motor symptoms, including dyskinesia, and non-motor symptoms impact health-related quality of life (HRQoL) in patients with Parkinson’s disease (PD), and that improvements in these metrics are correlated. Objective: Investigate the relationship between HRQoL and measures of PD severity and treatment efficacy, including motor and non-motor symptoms. Methods: This was a planned investigation of an international, prospective, single-arm, post-marketing observational study of the long-term effectiveness of levodopa-carbidopa intestinal gel (LCIG) in patients with advanced PD. Pearson correlation coefficients (PCC) were calculated for baseline and change from baseline at 12 months between HRQoL and motor and non-motor symptoms. Results: A total of 195 patients were included. At baseline, HRQoL was moderately positively correlated with Activities of Daily Living (UPDRS II, PCC = 0.44), non-motor symptoms (0.48), and measures of sleep (0.50 and 0.40); all p < 0.001. After 12 months of treatment with LCIG, improvements in HRQoL were moderately positively correlated with improvement from baseline in non-motor symptoms (PCC = 0.42), sleep (0.54), and daytime sleepiness (0.40; all p < 0.001), and weakly correlated with improvement in dyskinesia signs and symptoms (PCC = 0.23; p = 0.011). Improvement in HRQoL was not correlated with improvements in OFF time or dyskinesia time. Conclusion: Both at baseline and for change from baseline at 12 months, HRQoL was correlated with baseline and change from baseline in dyskinesia, Activities of Daily Living, and non-motor symptoms, including sleep; but not with baseline or change in OFF time.
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Affiliation(s)
| | | | | | - Esther Cubo
- Neurology Department, Hospital Universitario Burgos, Burgos, Spain
| | | | - Robert Iansek
- Kingston Centre, Monash Health, Melbourne, Australia
| | | | - Mihaela Simu
- Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
| | | | - K. Ray Chaudhuri
- Parkinson’s Foundation International Centre of Excellence, King’s College Hospital, London, UK
- King’s College Institute of Psychiatry, Psychology & Neuroscience, London, UK
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22
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Antonini A, Pahwa R, Odin P, Isaacson SH, Merola A, Wang L, Kandukuri PL, Alobaidi A, Yan CH, Bao Y, Zadikoff C, Parra JC, Bergmann L, Chaudhuri KR. Comparative Effectiveness of Device-Aided Therapies on Quality of Life and Off-Time in Advanced Parkinson's Disease: A Systematic Review and Bayesian Network Meta-analysis. CNS Drugs 2022; 36:1269-1283. [PMID: 36414908 PMCID: PMC9712309 DOI: 10.1007/s40263-022-00963-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/29/2022] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Research comparing levodopa/carbidopa intestinal gel (LCIG), deep brain stimulation (DBS), and continuous subcutaneous apomorphine infusion (CSAI) for advanced Parkinson's disease (PD) is lacking. This network meta-analysis (NMA) assessed the comparative effectiveness of LCIG, DBS, CSAI and best medical therapy (BMT) in reducing off-time and improving quality of life (QoL) in patients with advanced PD. METHODS A systematic literature review was conducted for randomized controlled trials (RCTs), observational and interventional studies from January 2003 to September 2019. Data extracted at baseline and 6 months were off-time, as reported by diary or Unified Parkinson's Disease Rating Scale Part IV item 39, and QoL, as reported by Parkinson's Disease Questionnaire (PDQ-39/PDQ-8). Bayesian NMA was performed to estimate pooled treatment effect sizes and to rank treatments in order of effectiveness. RESULTS A total of 22 studies fulfilled the inclusion criteria (n = 2063 patients): four RCTs, and 16 single-armed, one 2-armed and one 3-armed prospective studies. Baseline mean age was between 55.5-70.9 years, duration of PD was 9.1-15.3 years, off-time ranged from 5.4 to 8.7 h/day in 9 studies, and PDQ scores ranged from 28.8 to 67.0 in 19 studies. Levodopa/carbidopa intestinal gel and DBS demonstrated significantly greater improvement in off-time and QoL at 6 months compared with CSAI and BMT (p < 0.05). There was no significant difference in the effects of LCIG and DBS, but DBS was ranked first for reduction in off-time, and LCIG was ranked first for improvement in QoL. CONCLUSIONS This NMA found that LCIG and DBS were associated with superior improvement in off-time and PD-related QoL compared with CSAI and BMT at 6 months after treatment initiation. This comparative effectiveness research may assist providers, patients, and caregivers in the selection of the optimal device-aided therapy.
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Affiliation(s)
- Angelo Antonini
- Parkinson and Movement Disorders Unit, Department of Neuroscience, Study Center for Neurodegeneration (CESNE), University of Padova, 35128, Padua, Italy.
| | - Rajesh Pahwa
- Medical Center, University of Kansas, Kansas City, KS USA
| | - Per Odin
- University of Lund, Lund, Sweden
| | | | - Aristide Merola
- Department of Neurology, The Ohio State University Wexner Medical Center, Columbus, OH USA
| | - Lin Wang
- AbbVie Inc., North Chicago, IL USA ,Johns Hopkins School of Public Health, Baltimore, MD USA
| | | | - Ali Alobaidi
- AbbVie Inc., North Chicago, IL USA ,University of Illinois at Chicago, Chicago, IL USA
| | - Connie H. Yan
- AbbVie Inc., North Chicago, IL USA ,University of Illinois at Chicago, Chicago, IL USA
| | | | | | | | | | - K. Ray Chaudhuri
- King’s College and Parkinson Foundation Centre of Excellence, Kings College Hospital London, London, UK
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