Burden of non‐motor symptoms in Parkinson's disease patients predicts improvement in quality of life during treatment with levodopa‐carbidopa intestinal gel

Antonini, Angelo; Robieson, Weining; Sánchez-Soliño, O.; Bergmann, Lars; Poewe, Werner

doi:10.1111/ene.13847

Cited by 25 publications

(31 citation statements)

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“…Assessment of NMSs in PD are now key to value‐based health care and recommended by patient‐led organizations and the International Parkinson and Movement Disorder Society (IPMDS) . The availability of the NMSS has also allowed NMSs to be assessed in many clinical trials . The impact of NMS burden on quality of life across all stages of PD is now well established, and the NMSS has been used in PD subtyping studies …”

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confidence: 99%

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The Movement Disorder Society Nonmotor Rating Scale: Initial Validation Study

et al. 2019

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Background The Movement Disorder Society–sponsored Nonmotor Rating Scale is an update of the existing Parkinson's disease Nonmotor Symptoms Scale modified to address some limitations in Nonmotor Symptoms Scale scoring, structure, and symptom coverage. Methods PD patients were recruited from movement disorder centers in an international, multicenter study. The Movement Disorder Society Nonmotor Rating Scale, consisting of 13 domains plus a subscale for nonmotor fluctuations, was rater administered, along with the Nonmotor Symptoms Scale and other clinical assessments. Standard reliability and validity testing were conducted. Results Four hundred and two PD patients were recruited (mean age ± standard deviation, 67.42 ± 9.96 years; mean age at PD onset ± standard deviation, 59.27 ± 10.67 years; median Hoehn and Yahr stage 2 (interquartile range 2–3). Data quality was satisfactory for all Movement Disorder Society Nonmotor Rating Scale domains except sexual (6.7% missing data). There were no floor or ceiling effects for the Movement Disorder Society Nonmotor Rating Scale and nonmotor fluctuations total score; domains had no ceiling effects, but some floor effects (13.5%–83.5%). The Movement Disorder Society Nonmotor Rating Scale and nonmotor fluctuations total score internal consistency were acceptable (average Cronbach's alpha, 0.66 and 0.84, respectively); interrater reliability was excellent (intraclass correlation coefficient, >0.95); for test‐retest reliability, the intraclass correlation coefficient was 0.84 for the Movement Disorder Society Nonmotor Rating Scale and 0.70 for Movement Disorder Society nonmotor fluctuations total score, and precision was excellent for the Movement Disorder Society Nonmotor Rating Scale (standard error of measurement, 25.30) and fair for nonmotor fluctuations (standard error of measurement, 7.06). Correlations between Movement Disorder Society Nonmotor Rating Scale score and the corresponding Nonmotor Symptoms Scale and Movement Disorder Society UPDRS scores were high. There were no significant sex or age effects. The Movement Disorder Society Nonmotor Rating Scale score increased with increasing PD duration, disease severity, and PD medication dose (all P < 0.001). Conclusions The Movement Disorder Society Nonmotor Rating Scale is a valid measure for measuring the burden of a wide range of Nonmotor Rating Scale scores, including nonmotor fluctuations, in PD patients. © 2019 International Parkinson and Movement Disorder Society

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confidence: 99%

“…3 The availability of the NMSS has also allowed NMSs to be assessed in many clinical trials. [4][5][6][7][8][9][10][11][12] The impact of NMS burden on quality of life across all stages of PD is now well established, and the NMSS has been used in PD subtyping studies. 13,14 The NMSS was developed approximately 15 years ago.…”

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confidence: 99%

The Movement Disorder Society Nonmotor Rating Scale: Initial Validation Study

et al. 2019

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“…Other studies reported that some NMS are more frequent in patients with motor complications [2,7], as in our stduy. All of these data suggest a link between motor and NMS [16]. Fatigue, difficulty concentrating, sadness, pain and other sensory symptoms are some examples of NMS frequently related to OFF state [14].…”

Section: Discussionmentioning

confidence: 99%

Non‐motor symptom burden is strongly correlated to motor complications in patients with Parkinson’s disease

Santos‐García

Fonticoba

Castro

et al. 2020

Euro J of Neurology

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Background and purpose The objective of this study was to analyze the relationship between motor complications and non‐motor symptom (NMS) burden in a population of patients with Parkinson’s disease (PD) and also in a subgroup of patients with early PD. Methods Patients with PD from the COPPADIS cohort were included in this cross‐sectional study. NMS burden was defined according to the Non‐Motor Symptoms Scale (NMSS) total score. Unified Parkinson’s Disease Rating Scale (UPDRS) part IV was used to establish motor complication types and their severity. Patients with ≤5 years of symptoms from onset were included as patients with early PD. Results Of 690 patients with PD (62.6 ± 8.9 years old, 60.1% males), 33.9% and 18.1% presented motor fluctuations and dyskinesia, respectively. The NMS total score was higher in patients with motor fluctuations (59.2 ± 43.1 vs. 38.3 ± 33.1; P < 0.0001) and dyskinesia (63.5 ± 40.7 vs. 41.4 ± 36.3; P < 0.0001). In a multiple linear regression model and after adjustment for age, sex, disease duration, Hoehn & Yahr stage, UPDRS‐III score and levodopa equivalent daily dose, UPDRS‐IV score was significantly related to a higher NMSS total score (β = 0.27; 95% confidence intervals, 2.81–5.61; P < 0.0001), as it was in a logistic regression model on dichotomous NMSS total score (≤40, mild or moderate vs. >40, severe or very severe) (odds ratio, 1.31; 95% confidence intervals, 1.17–1.47; P < 0.0001). In the subgroup of patients with early PD (n = 396; mean disease duration 2.7 ± 1.5 years), motor fluctuations were frequent (18.1%) and similar results were obtained. Conclusions Motor complications were frequent and were associated with a greater NMS burden in patients with PD even during the first 5 years of disease duration.

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“…Efficacy of up to 16-hours continuous administration of LCIG in reducing motor fluctuations has been established in multiple prospective studies [6][7][8][9][10][11][12][13][14][15][16][17][18], and reviewed extensively [2,[19][20][21]. Although the pathogenesis of NMS remains partially unclear, 16-hour (16-h) continuous administration of LCIG has been associated with improvements in NMS, sleep quality, and quality-of-life measures (Table 1) [6,7,11,13,17,22,23].…”

Section: Overviewmentioning

confidence: 99%

“…Data from the GLORIA registry demonstrated improvements in patient quality of life and reductions in NMS, including sleep and fatigue [ 6 , 7 ]. In addition, baseline NMS burden was associated with improvements in NMS and quality of life [ 22 ]. Similarly, in the GREENFIELD observational cohort, significant improvements were observed in quality of life, NMS, and sleep [ 13 ].…”

Section: Levodopa-carbidopa Intestinal Gelmentioning

confidence: 99%

24-Hour Levodopa-Carbidopa Intestinal Gel: Clinical Experience and Practical Recommendations

et al. 2021

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Infusion of levodopa-carbidopa intestinal gel (LCIG; also designated carbidopa-levodopa enteral suspension) for 16 hours is a standard treatment for patients with advanced Parkinson's disease, and clinical observations suggest that 24-hour LCIG infusion may further reduce symptoms. This review provides practical advice on the management of patients transitioning to 24-hour LCIG infusion. We review available clinical data for 24-hour infusion and discuss adjustments to dosing, recommendations for monitoring, and management of patient concerns, based on our clinical experience. Data from multiple studies suggest that LCIG may improve non-motor symptoms. Although few studies have examined 24-hour LCIG infusion, available data indicate that certain patients may benefit from around-the-clock treatment. Studies of 24-hour LCIG infusion are limited by small sample sizes and open-label study designs, which may hamper translation to clinical practice. In our experience, we have found that patients may benefit from 24-hour infusion when reductions in nocturnal symptoms and improvements to quality of sleep are needed. Levodopa-unresponsive freezing of gait or poorly controlled troublesome dyskinesias may also indicate a patient may benefit from 24-hour infusion. Dose adjustments, especially of the nocturnal rate, are typically necessary and, as with 16-hour infusion, patients should be monitored for autonomic dysfunction; overnight wearing off symptoms; weight changes; fluctuations in plasma levels of vitamins B 6 /B 12 , folate, and homocysteine; changes in sleep patterns; or worsening of hallucinations, delusions, and/or nightmares. Available data and our clinical experience suggest that 24-hour LCIG may be warranted among selected patients who have poorly controlled nocturnal fluctuations or early morning "off" symptoms.

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Burden of non‐motor symptoms in Parkinson's disease patients predicts improvement in quality of life during treatment with levodopa‐carbidopa intestinal gel

Cited by 25 publications

References 35 publications

The Movement Disorder Society Nonmotor Rating Scale: Initial Validation Study

The Movement Disorder Society Nonmotor Rating Scale: Initial Validation Study

Non‐motor symptom burden is strongly correlated to motor complications in patients with Parkinson’s disease

24-Hour Levodopa-Carbidopa Intestinal Gel: Clinical Experience and Practical Recommendations

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