Neurotherapeutics,
Год журнала:
2023,
Номер
21(3), С. e00310 - e00310
Опубликована: Дек. 28, 2023
Parkinson's
disease
is
characterized
by
its
cardinal
motor
symptoms:
bradykinesia,
rigidity,
tremor,
and
postural
instability.
The
underlying
physiological
dysfunction
includes
basal
ganglia
pathways
that
contribute
to
both
non-motor
symptoms.
These
can
be
influenced
neural
network
modulation
through
the
application
of
electrical
or
magnetic
fields.
Neuromodulation
therapy
also
used
target
symptom-specific
networks.
Deep
brain
stimulation
(DBS)
an
example
effective
neuromodulatory
approach,
mainly
for
treatment
DBS
has
evolved
over
last
three
decades
several
technological
advances
including
imaging-guided
planning,
leads
with
sensing
capabilities,
closed-loop
stimulation,
segmented
directional
steering.
Less
invasive
forms
neuromodulation
have
been
introduced
these
techniques
leverage
disease-specific
networks
transcranial
direct
current
electroconvulsive
therapy.
Newer
approaches
emerged
in
laboratory
setting
temporal
interference
low-frequency
focused
ultrasound,
magnetoelectric
stimulation.
We
will
review
emerging
therapies
their
potential
PD.
Neurology and Therapy,
Год журнала:
2023,
Номер
12(6), С. 1937 - 1958
Опубликована: Авг. 26, 2023
Foslevodopa/foscarbidopa,
a
soluble
formulation
of
levodopa/carbidopa
(LD/CD)
prodrugs
for
the
treatment
Parkinson's
disease
(PD),
is
administered
as
24-hour/day
continuous
subcutaneous
infusion
(CSCI)
with
single
site.
The
efficacy
and
safety
foslevodopa/foscarbidopa
versus
oral
immediate-release
LD/CD
was
previously
demonstrated
in
patients
PD
12-week,
randomized,
double-blind,
phase
3
trial
(NCT04380142).
We
report
results
separate
52-week,
open-label,
registrational
(NCT03781167)
that
evaluated
safety/tolerability
CSCI
advanced
PD.
Male
female
levodopa-responsive
≥
2.5
hours
"Off"
time/day
received
at
individually
optimized
therapeutic
doses
(approximately
700–4250
mg
LD
per
24
hours)
52
weeks.
primary
endpoint
safety/tolerability.
Secondary
endpoints
included
changes
from
baseline
normalized
"On"
time,
percentage
reporting
morning
akinesia,
Movement
Disorder
Society
Unified
Disease
Rating
Scale
(MDS-UPDRS),
Sleep
Scale–2
(PDSS-2),
39-item
Questionnaire
(PDQ-39),
EuroQol
5-dimension
questionnaire
(EQ-5D-5L).
Of
244
enrolled
patients,
107
discontinued,
137
completed
treatment.
Infusion
site
events
were
most
common
adverse
(AEs).
AEs
mostly
nonserious
(25.8%
reported
serious
AEs)
mild/moderate
severity.
At
week
52,
time
without
troublesome
dyskinesia
improved
(mean
[standard
deviation
(SD)]
change
dyskinesia,
3.8
[3.3]
hours;
−3.5
[3.1]
hours).
experiencing
akinesia
dropped
77.7%
to
27.8%
52.
quality
(PDSS-2)
life
(PDQ-39
EQ-5D-5L)
also
improved.
Foslevodopa/foscarbidopa
has
potential
provide
safe
efficacious,
individualized,
24-hour/day,
nonsurgical
alternative
ClinicalTrials.gov
identifier
NCT03781167.
Frontiers in Neurology,
Год журнала:
2023,
Номер
14
Опубликована: Май 16, 2023
Parkinson's
disease
(PD)
is
characterized
by
a
variety
of
motor
and
non-motor
symptoms.
As
progresses,
fluctuations
in
the
response
to
levodopa
treatment
may
develop,
along
with
emergence
freezing
gait
(FoG)
induced
dyskinesia
(LiD).
The
optimal
management
symptoms
their
complications,
depends,
principally,
on
consistent
detection
course,
leading
improved
decisions.
During
last
few
years,
wearable
devices
have
started
be
used
clinical
practice
for
monitoring
patients'
PD-related
symptoms,
during
daily
activities.
This
work
describes
results
2
multi-site
studies
(PDNST001
PDNST002)
designed
validate
performance
wearability
new
device,
PDMonitor®,
For
studies,
65
patients
28
healthy
individuals
(controls)
were
recruited.
Specifically,
Phase
I
first
study,
participants
device
2-6
h
clinic
while
neurologists
assessed
exhibited
parkinsonian
every
half
hour
using
Unified
Disease
Rating
Scale
(UPDRS)
Part
III,
as
well
Abnormal
Involuntary
Movement
(AIMS)
severity
assessment.
goal
was
data
gathering.
On
other
hand,
II
second
study
(PDNST002),
day-to-day
variability
evaluated,
former
control
subjects
latter.
In
both
cases,
number
days,
being
unsupervised
free
perform
any
kind
produced
estimations
majority
fluctuations.
Statistical
analysis
demonstrated
that
accuracy
correlation
between
expert
evaluations
high.
result,
confirmed
effectiveness
system
continuous
telemonitoring
solution,
easy
facilitate
decision-making
disease.
Movement Disorders Clinical Practice,
Год журнала:
2025,
Номер
unknown
Опубликована: Фев. 11, 2025
Abstract
Background
Although
there
are
established
guidelines
for
the
selection
of
suitable
candidates,
objective
and
timely
referral
use
apomorphine
remains
challenging.
Objectives
This
research
examined
how
telemonitoring
may
facilitate
referrals
continuous
subcutaneous
infusion
in
Parkinson's
disease
(PD).
Methods
A
Blind
Rater
a
multi‐disciplinary
team
(MDT)
including
an
expert
PD
nurse,
neurologist,
geriatrician
determined
pump
treatment
eligibility
20
patients
with
PD.
The
MDT
considered
data
physical
examination
to
determine
eligibility.
used
only
(PDMonitor®)
evaluate
Results
results
show
that
using
wearable
sensors
appropriateness
is
similar
complete
method
combines
motor
symptom
monitoring
clinical
evaluation.
blind
rater
had
0.89
Cohen's
kappa
coefficient,
which
suggests
high
rate
agreement.
best‐performing
metric
differentiating
who
were
recommended
(APO)
from
those
non‐recommended
(non‐APO)
therapy,
was
device‐reported
percentage
time
“ON”
state,
takes
into
consideration
“OFF”
dyskinesia
time.
APO
group
lower
values
this
could
be
differentiated
non‐APO
accurately
(85%).
Conclusions
Using
therapy
might
improve
evaluation
and,
therefore
help
their
quality
life.
Patient,
Год журнала:
2024,
Номер
17(3), С. 275 - 285
Опубликована: Янв. 5, 2024
Early
detection
of
Parkinson's
Disease
(PD)
progression
remains
a
challenge.
As
remote
patient
monitoring
solutions
(RMS)
and
artificial
intelligence
(AI)
technologies
emerge
as
potential
aids
for
PD
management,
there's
gap
in
understanding
how
end
users
view
these
technologies.
This
research
explores
neurologist
perspectives
on
AI-assisted
RMS.
European Journal of Neurology,
Год журнала:
2025,
Номер
32(2)
Опубликована: Фев. 1, 2025
ABSTRACT
Background
Parkinson's
disease
(PD)
treatments,
such
as
apomorphine
(APO)
and
levodopa–carbidopa
intestinal
gel
(LCIG),
represent
advanced
therapeutic
options
for
managing
motor
symptoms.
However,
clear
selection
criteria
well‐defined
cognitive
outcomes
are
lacking.
This
systematic
review
specifically
aimed
to
address
these
gaps
by
assessing
the
impact
of
APO
LCIG
in
PD
patients.
Methods
A
was
conducted
following
PRISMA
guidelines,
with
searches
PubMed,
Web
Science,
Scopus,
Embase.
Two
authors
screened
studies
based
on
key
inclusion
criteria,
including
at
least
two
tests,
a
follow‐up
6
months
or
more.
The
risk
bias
evaluated
using
Newcastle–Ottawa
Scale
(NOS).
Results
Fifteen
were
identified
(7
8
LCIG).
generally
preserved
function
over
12‐month
follow‐up,
some
decreases
visuospatial
memory
executive
functions.
LCIG,
28‐month
showed
more
extensive
decline,
particularly
patients
pre‐existing
impairments.
Variability
tests
made
direct
comparisons
difficult.
Discussion
may
have
favorable
profile
than
LCIG.
differences
duration,
moderate
bias,
inconsistent
assessments
warrant
cautious
interpretation.
Improved
patient
comprehensive
evaluations
recommended
future
practice.
Expert Review of Medical Devices,
Год журнала:
2025,
Номер
unknown
Опубликована: Май 7, 2025
Device-aided
therapies
(DATs)
have
been
developed
to
provide
continuous
drug
delivery
(CDD)
people
with
advanced
Parkinson's
disease
(PD)
whose
symptoms
can
no
longer
be
effectively
managed
oral
or
transdermal
therapy.
Intrajejunal
infusion
of
levodopa
-
carbidopa
intestinal
gel
(LCIG),
delivered
via
the
CADD
Legacy
1400
pump,
is
an
established
CDD
option,
while
entacapone
(LECIG),
Crono
LECIG
a
more
recent
addition
range
DAT
options
in
Europe.
This
article
explores
rationale
for
development
infusion,
role
formulation,
and
attributes
specifications
pump
device.
Clinical
real-world
data
reporting
its
efficacy,
safety
tolerability
PD
patients
from
European
centers
are
reviewed,
focus
on
practical
benefits
that
smaller,
lighter
quieter
device
who
wish
start
treatment
intrajejunal
infusion.
offers
another
valuable
option
consider
suitable
providing
both
good
long-term
clinical
favorable
experience
patients.
Journal of Neural Transmission,
Год журнала:
2023,
Номер
130(11), С. 1411 - 1432
Опубликована: Июль 12, 2023
Abstract
Device-aided
therapies
(DAT),
which
include
deep
brain
stimulation
and
pump-based
continuous
dopaminergic
with
either
levodopa
or
apomorphine,
are
among
the
major
advances
in
clinical
management
of
Parkinson’s
disease
(PD).
Although
DAT
being
increasingly
offered
earlier
course,
their
classical
indication
remains
advanced
PD.
Theoretically,
every
patient
should
be
transition
to
when
faced
refractory
motor
nonmotor
fluctuations
functional
decline.
Worldwide
reality
is
far
from
these
ideal,
and,
therefore,
question
“real-world”
equal
opportunity
access
for
PD
patients
PD—even
within
a
single
health
care
system.
Differences
care,
referral
pattern
(timing
frequency),
as
well
physician
biases
(unconscious/implicit
conscious/explicit
bias),
patients’
preferences
health-seeking
behaviour
considered.
Compared
DBS,
little
information
available
concerning
infusion
therapies,
neurologists’
attitudes
towards
them.
This
viewpoint
aims
thought-provoking
assist
clinicians
moving
through
process
selection,
by
including
decision
algorithm
own
biases,
perspective,
ethical
concerns
current
unknowns
surrounding
prognosis
DAT-related
long-term
side
effects
given
patient.
Journal of Parkinson s Disease,
Год журнала:
2023,
Номер
13(5), С. 641 - 657
Опубликована: Июнь 13, 2023
Oral
levodopa
is
the
gold-standard
therapy
for
treating
Parkinson’s
disease
(PD)
but
after
a
few
years
of
treatment
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
levodopa-carbidopa
intestinal
gel
(LCIG;
or
carbidopa-levodopa
enteral
suspension),
levodopa-carbidopa-entacapone
gel,
subcutaneous
apomorphine
infusion.
Consideration
initiation
infusion
therapies
are
suggested
before
onset
major
disability.
The
present
review
summarizes
clinical
evidence
management,
discusses
available
screening
tools
PD,
provides
considerations
around
optimal
use
therapy.
Neurologia i Neurochirurgia Polska,
Год журнала:
2024,
Номер
58(3), С. 283 - 291
Опубликована: Май 14, 2024
Unilateral
gamma
knife
thalamotomy
(GKT)
is
a
treatment
option
for
pharmacoresistant
tremor
of
various
aetiologies.
There
have
been
to
date
no
randomised
controlled
trials
performed
assess
its
safety
and
efficacy.
Our
aim
was
summarise
two-year
multimodal
observation
patients
with
caused
by
Parkinson's
Disease
(PD)
or
essential
(ET).