Rationale and patient selection for interventional therapies in Parkinson’s disease

ABSTRACT

Introduction: Parkinson’s disease (PD) is increasing in prevalence due to a growing elderly population. Although there is no cure, there are exercise therapies and medications for mild to moderate disease. For more advanced disease, infusion or surgical interventions including deep brain stimulation surgery, levodopa carbidopa intestinal gel, and subcutaneous apomorphine infusion are considered. As these interventions become increasingly available, it is imperative for a neurologist involved in the care of advanced PD to be aware of the indications and timing for these interventions.

Areas covered: This article attempts to identify different patient profiles and matches them with suggested advanced therapies for PD. There is limited literature providing guidance to a busy neurologist to match the most appropriate advanced therapy to the right patient profile. This article attempts to fill that void.

Expert commentary: When matching patient profiles to therapy, several features must be considered: age, frailty, cognitive status, phenotype (predominant tremor vs. akinetic rigid), side effect or complication profile (dyskinesia, hallucinations, dysautonomia), and patient’s comfort with invasive therapy options.

KEYWORDS:

• Parkinson’s disease
• advanced therapies
• deep brain stimulation
• levodopa carbidopa intestinal gel
• subcutaneous apomorphine infusion

Declaration of interest

A Wagle-Shukla reports grants from the NIH and grant support from: Benign Essential Blepharospasm Research Foundation, Dystonia Coalition, Dystonia Medical Research Foundaiton, National Organization for Rare Disorders and NIH (KL2 and K23 NS092957-01A1). R Mehanna is on the speakers’ bureau for Teva Pharmaceutical and Adamas Pharmaceutical and has received honoraria from Global Kinetic Corporation, Neurocrine, Sunovio, and Merz. D Ghazi Bhatti has served as a speaker/advisor for Adamas, Accadia, Merz, Teva, Abbvie, and Allergan Pakistan. B Kelly Changizi has previously received consulting fees from Medtronic. HH Fernandez has received grants/support from Abbvie, Biotie/Acorda Therapeutics, Michael J Fox Foundation, Movement Disorders Society, NIH/NINDS, Parkinson Study Group, Rhythm, Sunovion; has received speaking honoraria from Prime Education Inc., International Parkinson and Movement Disorders Society, Carling Communications, Medscape, and Vindico; has received consulting honoraria from AbbVie, Biogen, Blackthorn, Inventiv, Kyowa Hakko Kirin, Medscape, Voyager, Sunovion, and Pfizer; has received royalties from Demos Publishing and Cambridge University Press; their clinic – The Cleveland Clinic – has a contract with Teva for their role as a Co-principal investigator on SD-809 tardive dyskinesia global studies; and this author serves as a member of the publication committee for Acorda and Biotie Pharmaceuticals but does not receive any compensation for this. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.