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Moes HR, Dafsari HS, Jost WH, Kovacs N, Pirtošek Z, Henriksen T, Falup-Pecurariu C, Minár M, Buskens E, van Laar T. Grasping the big picture: impact analysis of screening tools for timely referral for device-aided therapies. J Neural Transm (Vienna) 2024:10.1007/s00702-024-02783-1. [PMID: 39007919 DOI: 10.1007/s00702-024-02783-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Accepted: 05/03/2024] [Indexed: 07/16/2024]
Abstract
Several screening tools are available to assist general neurologists in the timely identification of patients with advanced Parkinson's disease (PD) who may be eligible for referral for a device-aided therapy (DAT). However, it should be noted that not all of these clinical decision rules have been developed and validated in a thorough and consistent manner. Furthermore, only a limited number of head-to-head comparisons have been performed. Available studies suggest that D-DATS has a higher positive predictive value and higher specificity than the 5-2-1 criteria, while the sensitivity of both screening tools is similar. However, unanswered questions remain regarding the validity of the decision rules, such as whether the diagnostic performance measures from validation studies are generalizable to other populations. Ultimately, the question is whether a screening tool will effectively and efficiently improve the quality of life of patients with PD. To address this key question, an impact analysis should be performed. The authors intend to set up a multinational cluster randomised controlled trial to compare the D-DATS and 5-2-1 criteria on the downstream consequences of implementing these screening tools, with a particular focus on the impact on disability and quality of life.
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Affiliation(s)
- H R Moes
- Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
| | - H S Dafsari
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - W H Jost
- Parkinson-Klinik Ortenau, Kreuzbergstr. 12‑16, Wolfach, 77709, Germany
| | - N Kovacs
- Department of Neurology, University of Pecs, Medical School, 48-as tér 1, Pecs, Hungary
| | - Z Pirtošek
- Department of Neurology, University Medical Center, Ljubljana, Slovenia
- Department of Neurology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - T Henriksen
- Movement Disorder Clinic, University Hospital of Bispebjerg, Copenhagen, Denmark
| | - C Falup-Pecurariu
- Department of Neurology, Faculty of Medicine, County Clinic Hospital, Faculty of Medicine, Transylvania University, Braşov, Romania
| | - M Minár
- Second Department of Neurology, Faculty of Medicine, Comenius University Bratislava, Bratislava, Slovakia
| | - E Buskens
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - T van Laar
- Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Südmeyer M, Pedrosa DJ, Siebecker F, Arlt C, Kopra JJ, Jost WH. Utilization of MANAGE-PD Tool in a Real-World Setting in Germany: A Cross-Sectional Study. Brain Sci 2024; 14:630. [PMID: 39061371 PMCID: PMC11275059 DOI: 10.3390/brainsci14070630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Revised: 06/18/2024] [Accepted: 06/19/2024] [Indexed: 07/28/2024] Open
Abstract
MANAGE-PD is a validated, web-based tool to assist physicians in identifying patients with Parkinson's disease (PD) whose symptoms are inadequately controlled by oral medication. Also, a modified patient version of MANAGE-PD (Parkinson Check) is available in Germany. However, prospective research into the clinical utility of MANAGE-PD is lacking. This non-interventional study aimed to assess the real-world clinical utility of the MANAGE-PD and Parkinson Check in PD patients attending a single visit at specialist clinics and neurologist practices in Germany in 2022. Participants' disease control was rated by the physicians using their own judgment, and by completing the MANAGE-PD, and by the patients completing the Parkinson Check. Concordance was calculated between the unassisted physician's assessment and the outcome of MANAGE-PD, as well as the Parkinson Check. A total of 278 patients from 19 sites were included in the analyses, of whom 160 patients (57.6%) were assigned to the same category of disease control by physicians' judgment and the MANAGE-PD. Concordance was higher in patients treated in specialist clinics (63.9%) than in neurologist practices (43.7%). Concordance between physicians' and patients' responses was high (>80%) for each question in the Parkinson Check. MANAGE-PD proved to be especially valuable for general neurologists in identifying patients who should be referred to specialist clinics. The Parkinson Check self-assessment generated promising outcomes that merit its more widespread use.
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Affiliation(s)
- Martin Südmeyer
- Department of Neurology, Ernst-von-Bergmann Klinikum, 14467 Potsdam, Germany
- Department of Neurology, Medical Faculty, University Düsseldorf, 40225 Düsseldorf, Germany
| | - David J. Pedrosa
- Department of Neurology, Philipps-University Marburg, 35037 Marburg, Germany;
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Auffret M, Weiss D, Stocchi F, Vérin M, Jost WH. Access to device-aided therapies in advanced Parkinson's disease: navigating clinician biases, patient preference, and prognostic uncertainty. J Neural Transm (Vienna) 2023; 130:1411-1432. [PMID: 37436446 PMCID: PMC10645670 DOI: 10.1007/s00702-023-02668-9] [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: 05/04/2023] [Accepted: 06/24/2023] [Indexed: 07/13/2023]
Abstract
Device-aided therapies (DAT), which include deep brain stimulation and pump-based continuous dopaminergic stimulation with either levodopa or apomorphine, are among the major advances in the clinical management of Parkinson's disease (PD). Although DAT are being increasingly offered earlier in the disease course, their classical indication remains advanced PD. Theoretically, every patient should be offered transition to DAT when faced with refractory motor and nonmotor fluctuations and functional decline. Worldwide clinical reality is far from these ideal, and, therefore, question the "real-world" equal opportunity of access to DAT for PD patients with advanced PD-even within a single health care system. Differences in access to care, referral pattern (timing and frequency), as well as physician biases (unconscious/implicit or conscious/explicit bias), and patients' preferences or health-seeking behaviour are to be considered. Compared to DBS, little information is available concerning infusion therapies, as well as neurologists' and patients' attitudes towards them. This viewpoint aims to be thought-provoking and to assist clinicians in moving through the process of DAT selection, by including in their decision algorithm their own biases, patient perspective, ethical concerns as well as the current unknowns surrounding PD prognosis and DAT-related long-term side effects for a given patient.
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Affiliation(s)
- Manon Auffret
- France Développement Electronique (FDE), Monswiller, France.
- Institut des Neurosciences Cliniques de Rennes (INCR), Rennes, France.
- Behavior and Basal Ganglia Research Unit, CIC-IT, CIC1414, Pontchaillou University Hospital and University of Rennes, Rennes, France.
| | - Daniel Weiss
- Centre for Neurology, Department for Neurodegenerative Diseases, Hertie-Institute for Clinical Brain Research, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
| | - Fabrizio Stocchi
- University San Raffaele Roma and Institute of Research and Medical Care IRCCS San Raffaele Roma, Rome, Italy
| | - Marc Vérin
- Institut des Neurosciences Cliniques de Rennes (INCR), Rennes, France
- Behavior and Basal Ganglia Research Unit, CIC-IT, CIC1414, Pontchaillou University Hospital and University of Rennes, Rennes, France
- Neurology Department, Pontchaillou University Hospital, rue Henri Le Guilloux, 35000, Rennes, France
| | - Wolfgang H Jost
- Parkinson-Klinik Ortenau, Kreuzbergstr. 12-16, 77709, Wolfach, Germany
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Fründt O, Hanff AM, Möhl A, Mai T, Kirchner C, Amouzandeh A, Buhmann C, Krüger R, Südmeyer M. Device-Aided Therapies in Parkinson's Disease-Results from the German Care4PD Study. Brain Sci 2023; 13:brainsci13050736. [PMID: 37239208 DOI: 10.3390/brainsci13050736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 04/23/2023] [Accepted: 04/27/2023] [Indexed: 05/28/2023] Open
Abstract
Data on the use of device-aided therapies (DATs) in people with Parkinson's disease (PwP) are scarce. Analyzing data from the Care4PD patient survey, we (1) evaluated application frequency and type of DAT in a larger, nationwide, cross-sectoral PwP sample in Germany; (2) analyzed the frequency of symptoms indicative for advanced PD (aPD) and need for DAT amongst the remaining patients and (3) compared the most bothersome symptoms and need for professional long-term care (LTC) of patients with and without suspected aPD. Data from 1269 PwP were analyzed. In total, 153 PwP (12%) received DAT, mainly deep brain stimulation (DBS). Of the remaining 1116 PwP without DAT, >50% fulfilled at least one aPD criterion. Akinesia/rigidity and autonomic problems were most bothersome for PwP with and without suspected aPD, with more tremor in the non-aPD and more motor fluctuations and falls in the aPD group. To recapitulate, the German DAT application rate is rather low, although a large proportion of PwP fulfills aPD criteria indicating a need for intensified treatment strategies. Many reported bothersome symptoms could be overcome with DAT with benefits even for LTC patients. Thus, precise and early identification of aPD symptoms (and therapy-resistant tremor) should be implemented in future DAT preselection tools and educational trainings.
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Affiliation(s)
- Odette Fründt
- Department of Neurology, Klinikum Ernst von Bergmann, Charlottenstraße 72, 14467 Potsdam, Germany
| | - Anne-Marie Hanff
- Transversal Translational Medicine, Luxembourg Institute of Health (LIH), 1A-B, Rue Thomas Edison, L-1445 Strassen, Luxembourg
- Faculty of Science, Technology and Medicine, University of Luxembourg, Belval Campus, Maison du Savoir, 2 Avenue de l'Université, L-4365 Esch-sur-Alzette, Luxembourg
- Department of Epidemiology, CAPHRI School for Public Health and Primary Care, Maastricht University Medical Centre, Postbus 5800, 6202 AZ Maastricht, The Netherlands
| | - Annika Möhl
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Tobias Mai
- Department of Nursing Development/Nursing Research, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany
| | - Christiane Kirchner
- Department of Neurology, Klinikum Ernst von Bergmann, Charlottenstraße 72, 14467 Potsdam, Germany
| | - Ali Amouzandeh
- Department of Neurology, Klinikum Ernst von Bergmann, Charlottenstraße 72, 14467 Potsdam, Germany
| | - Carsten Buhmann
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Rejko Krüger
- Transversal Translational Medicine, Luxembourg Institute of Health (LIH), 1A-B, Rue Thomas Edison, L-1445 Strassen, Luxembourg
- Luxembourg Centre for Systems Biomedicine (LCSB), University of Luxembourg, 6, Avenue du Swing, L-4367 Belvaux, Luxembourg
- Parkinson Research Clinic, Centre Hospitalier de Luxembourg (CHL), 4 Rue Nicolas Ernest Barblé, L-1210 Luxembourg, Luxembourg
| | - Martin Südmeyer
- Department of Neurology, Klinikum Ernst von Bergmann, Charlottenstraße 72, 14467 Potsdam, Germany
- Department of Neurology, University Medical Center Düsseldorf, Moorenstraße 5, 40225 Düsseldorf, Germany
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Szász JA, Constantin VA, Orbán-Kis K, Bancu LA, Bataga SM, Ciorba M, Nagy E, Neagoe MR, Mihály I, Szász RM, Kelemen K, Simu M, Szatmári S. Levodopa-Carbidopa Intestinal Gel in Advanced Parkinson's Disease: Observations and Dilemmas after 10 Years of Real-Life Experience. Pharmaceutics 2022; 14:1115. [PMID: 35745688 PMCID: PMC9231164 DOI: 10.3390/pharmaceutics14061115] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 05/19/2022] [Accepted: 05/20/2022] [Indexed: 12/04/2022] Open
Abstract
Advanced Parkinson's disease (APD) cannot be treated efficiently using the classical medications however, in recent decades invasive therapeutical methods were implemented and confirmed as effective. One of these methods makes it possible to continue the levodopa (LD) supplementation as a gel administered directly into the upper intestine. However, there are a number of unanswered questions regarding this method. Therefore, we retrospectively analyzed a 10-year period of selected patients that were treated with levodopa/carbidopa intestinal gel (LCIG). We included all APD patients with motor fluctuations and dyskinesia at presentation. LCIG treatment was started in 150 patients: on average these patients received LD for 10.6 ± 4.4 years with a frequency of 5.2 ± 1.0/day until the introduction of LCIG. The estimated and the real LCIG dose differed significantly (mean: 1309 ± 321 mg vs. 1877 ± 769 mg). The mean duration of LCIG administration was 19.8 ± 3.6 h, but in a number of 62 patients we had to administer it for 24 h, to maximize the therapeutic benefit. A carefully and individually adjusted LCIG treatment improves the quality of life of APD patients, but questions remain unresolved even after treating a large number of patients. It is important to share the ideas and observations based on the real-life experience related to the optimal timing, the appropriate dose and duration of administration of the LCIG.
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Affiliation(s)
- József Attila Szász
- 2nd Clinic of Neurology, Târgu Mureș County Emergency Clinical Hospital, 540136 Târgu Mureș, Romania; (J.A.S.); (V.A.C.); (K.K.); (S.S.)
- Department of Neurology, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, 540139 Târgu Mureș, Romania;
| | - Viorelia Adelina Constantin
- 2nd Clinic of Neurology, Târgu Mureș County Emergency Clinical Hospital, 540136 Târgu Mureș, Romania; (J.A.S.); (V.A.C.); (K.K.); (S.S.)
- Doctoral School, ”Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania
| | - Károly Orbán-Kis
- 2nd Clinic of Neurology, Târgu Mureș County Emergency Clinical Hospital, 540136 Târgu Mureș, Romania; (J.A.S.); (V.A.C.); (K.K.); (S.S.)
- Department of Physiology, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, 540139 Târgu Mureș, Romania;
| | - Ligia Ariana Bancu
- Department of Internal Medicine, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, 540139 Târgu Mureș, Romania;
- 1st Clinic of Internal Medicine, Târgu Mureș County Emergency Clinical Hospital, 540142 Târgu Mureș, Romania
| | - Simona Maria Bataga
- Department of Gastroenterology, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, 540139 Târgu Mureș, Romania; (S.M.B.); (M.C.)
- Department of Gastroenterology, Târgu Mureș County Emergency Clinical Hospital, 540142 Târgu Mureș, Romania
| | - Marius Ciorba
- Department of Gastroenterology, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, 540139 Târgu Mureș, Romania; (S.M.B.); (M.C.)
- Department of Gastroenterology, Târgu Mureș County Emergency Clinical Hospital, 540142 Târgu Mureș, Romania
| | - Előd Nagy
- Department of Biochemistry, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, 540139 Târgu Mureș, Romania;
- Laboratory of Medical Analysis, Clinical County Hospital Mures, 540142 Târgu Mureș, Romania
| | - Mircea Radu Neagoe
- Department of Surgery, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, 540139 Târgu Mureș, Romania;
- 2nd Clinic of Surgery, Târgu Mures County Emergency Clinical Hospital, 540136 Târgu Mures, Romania
| | - István Mihály
- Department of Physiology, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, 540139 Târgu Mureș, Romania;
- Department of Neurology, Emergency County Hospital Miercurea Ciuc, 530173 Miercurea Ciuc, Romania
| | - Róbert Máté Szász
- Department of Neurology, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, 540139 Târgu Mureș, Romania;
| | - Krisztina Kelemen
- 2nd Clinic of Neurology, Târgu Mureș County Emergency Clinical Hospital, 540136 Târgu Mureș, Romania; (J.A.S.); (V.A.C.); (K.K.); (S.S.)
- Department of Physiology, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, 540139 Târgu Mureș, Romania;
| | - Mihaela Simu
- Department of Neurology, ”Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania;
- ”Pius Branzeu” Emergency Clinical County Hospital, 300723 Timisoara, Romania
| | - Szabolcs Szatmári
- 2nd Clinic of Neurology, Târgu Mureș County Emergency Clinical Hospital, 540136 Târgu Mureș, Romania; (J.A.S.); (V.A.C.); (K.K.); (S.S.)
- Department of Neurology, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, 540139 Târgu Mureș, Romania;
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