Georgiev, D.; Delalić, S.; Zupančič Križnar, N.; Socher, A.; Gurevich, T.; Trošt, M. Switching and Combining Device-Aided Therapies in Advanced Parkinson’s Disease: A Double Centre Retrospective Study. Brain Sci.2022, 12, 343.
Georgiev, D.; Delalić, S.; Zupančič Križnar, N.; Socher, A.; Gurevich, T.; Trošt, M. Switching and Combining Device-Aided Therapies in Advanced Parkinson’s Disease: A Double Centre Retrospective Study. Brain Sci. 2022, 12, 343.
Georgiev, D.; Delalić, S.; Zupančič Križnar, N.; Socher, A.; Gurevich, T.; Trošt, M. Switching and Combining Device-Aided Therapies in Advanced Parkinson’s Disease: A Double Centre Retrospective Study. Brain Sci.2022, 12, 343.
Georgiev, D.; Delalić, S.; Zupančič Križnar, N.; Socher, A.; Gurevich, T.; Trošt, M. Switching and Combining Device-Aided Therapies in Advanced Parkinson’s Disease: A Double Centre Retrospective Study. Brain Sci. 2022, 12, 343.
Abstract
Background: Continuous subcutaneous apomorphine infusion (CSAI), levodopa-carbidopa intestinal gel infusion (LCIG), and deep brain stimulation of the subthalamic nucleus (STN-DBS) have markedly changed the treatment landscape of advanced Parkinson’s disease (aPD). Despite a similar outcome of all device-aided therapies (DATs), some patients switch or combine DATs. The aim of this retrospective study was to explore the frequency and reasons for switching between or combining DATs in two movement disorders centres in Slovenia and Israel. Methods: We collected and analysed demographic and clinical data from aPD patients who switched between or combined DATs. Motor and non-motor reasons and their frequency for switching/combining were examined, as was the effect of DAT using the Global Improvement subscale of the Clinical Global Impression Scale. Non-parametric tests were used to analyse the data. Results: Of 505 aPD patients treated with DATs at both centres between January 2009 and June 2021, we identified in total 30 patients (6%), who either switched DAT (N=24: 7 LCIG-to-STN-DBS, 1 LCIG-to-CSAI, 5 CSAI-to STN-DBS, 8 CSAI-to-LCIG, 1 STN-DBS-to-LCIG, 1 LCIG-to-CSAI-to-STN-DBS, and 1 STN-DBS-to-CSAI-to-LCIG) or combined DATs (N=6: 5 STN-DBS+LCIG and 1 STN-DBS+CSAI-to-STN-DBS+LCIG). In most of these patients, inadequate control of motor symptoms was the main reason for switching or combining DATs, but non-motor reasons (related to the disease and/or DAT) were also identified. Conclusions: Switching between and combining DATs is uncommon, but in some patients brings substantial clinical improvement and should be considered in those who have either inadequate symptom control on DAT treatment or have developed DAT related complications.
Keywords
Advanced Parkinson’s disease; Deep Brain Stimulation of the Subthalamic Nucleus; L-dopa/Carbidopa Intestinal Gel Infusion; Continuous Subcutaneous Apomorphine Infusion
Subject
Medicine and Pharmacology, Neuroscience and Neurology
Copyright:
This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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