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József Attila Szász,1,2,* Viorelia Adelina Constantin,2,3,* Károly Orbán-Kis,1,2 Attila Rácz,4 Ligia Ariana Bancu,1,5 Dan Georgescu,1,6 János Szederjesi,1,7 István Mihály,1,2 Ana-Mária Fárr,1 Krisztina Kelemen,1,2 Tamás Vajda,8 Szabolcs Szatmári1,2 1University of Medicine and Pharmacy of Târgu Mures, Târgu MureÅ, Romania; 22nd Clinic of Neurology, Târgu Mures County Emergency Clinical Hospital, Târgu Mures, Romania; 3Doctoral School, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania; 42nd Clinic of Psychiatry, Târgu Mures County Emergency Clinical Hospital, Târgu Mures, Romania; 51st Clinic of Internal Medicine, Târgu Mures County Emergency Clinical Hospital, Târgu Mures, Romania; 6Department of Gastroenterology, Târgu Mures County Emergency Clinical Hospital, Târgu Mures, Romania; 7Department of Anesthesiology and Intensive Care, Târgu Mures County Emergency Clinical Hospital, Târgu Mures, Romania; 8Department of Computer Science, Faculty of Technical and Human Sciences, Sapientia Hungarian University of Transylvania, Târgu MureÈ, Romania*These authors contributed equally to this workCorrespondence: Károly Orbán-Kis Gh. Marinescu Street No 38, Targu Mures 540142, RomaniaTel +40743754525Email karoly.orban-kis@umfst.roBackground: There is insufficient data in the literature regarding the real-life, daily clinical practice evaluation of patients with advanced Parkinson’s disease (APD). We are not sure what is the upper limit of dopaminergic medication, especially the levodopa (LD) dosage, and how it is influenced by access and suitability to the various add-on and device-aided therapies (DAT).Objective: This retrospective study explored the profile of APD patients that were considered and systematically evaluated regarding the suitability for DAT.Methods: We analyzed the data from 311 consecutive patients with APD hospitalized between 2011 and 2017 that 1) described at least 2 hrs/day off periods divided into at least two instances/day (except early morning akinesia), 2) were in stage 3 or above on the Hoehn and Yahr scale, 3) were with or without dyskinesia, and 4) received at least four levodopa doses/day combined with adjuvant therapy.Results: Of the 311 patients enrolled initially, 286 patients showed up for the second visit, of which in 125 cases we assessed that DAT would be necessary. Finally, 107 patients were tested in our clinic to confirm the efficacy of LCIG. Patients selected for DAT had significantly longer off periods, more frequent dyskinesia, early morning akinesia, and freezing despite having significantly higher LD doses than those with an improved conservative therapy.Conclusion: Patients with APD can have a variety of symptoms, and because symptoms and therapeutical efficacy can be manifested in many different combinations, it is not possible to decide using a single, rigid set of criteria which APD patient is eligible for DAT. Nevertheless, treating physicians should refer APD patients to a specialized movement disorder center when patients with an average daily dose of LD of at least 750–1000 mg and maximal complementary therapies present daily motor complications that significantly reduce the quality of life.Keywords: advanced Parkinson’s disease, motor complications, levodopa doses, levodopa-carbidopa intestinal gel |
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