Objective: To investigate the influence of neurorehabilitation on the dose changes of Parkinson medication over time. 

Background: In progressive disorders such as Parkinson’s disease (PD), medication needs to be regularly adapted for optimised symptom control. This is a challenge for physicians and patients alike. 

Methods: Parkinson medication was evaluated retrospectively in two groups of patients at two points of time (t1, t2): 
Group 1: 38 patients who had completed 4 weeks in-patient neurorehabilitation during 2014 (= t1) were contacted at least 12 months later (= t2); they were asked to complete a written questionnaire on their Parkinson medication at t2; 33 patients (f:14, m:19) returned the questionnaire. Average age: 70 years (range 55-82), average Hoehn & Yahr stage (H&Y) 2,5 (range 1,5-4). 
Group 2: 33 patients without neurorehabilitation (f:15, m:18); medication at t1 and at least 12 months later (=t2) was compared by the treating neurologist. Average age: 74 years (range 51-87), average H&Y: 2,5 (range 1,5-3,5). 
For both groups all PD medication was converted to Levodopa equivalent dose (LED) using a conversion table (Ref 1). The average change in LED per month was used in the analysis.
 

Results: Group 1 (33 patients with neuroreha): the average increase across 14 patients was 10,26mg LED; the average decrease in LED for 7 patients was -5,97mg, for 12 patients medication remained stable.
Group 2 (33 patients without neuroreha): the average increase for 32 patients was 10,46mg LED, there was only one patient with stable medication over time. None had their medication decreased. 
Analysis of gender showed a trend towards a higher increase in average LED across all female patients in both groups, whereby the average increase is three times as big in group 2 both in males and females. 
More patients did regular exercise (≥1h/day) in group 1 (27 patients) than in group 2 (20 patients). While in group 1 (neuroreha) 15 patients had a decreased or stable LED over time, this trend was not observed in group 2 (1 patient with stable LED but without regular exercise).  

Conclusions: In our small retrospective analysis we observed a trend towards more stable LED medication over time in patients with in-patient neurorehabilitation. This group was also physically more active. Additional patient data needs to be analysed, such as the influence of disease duration, H&Y or comorbidities. 

References: (1) http://www.parkinsonsmeasurement.org/toolBox/levodopaEquivalentDose.htm

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MDS Abstracts - https://www.mdsabstracts.org/abstract/the-influence-of-neurorehabilitation-on-parkinson-medication/