Objective: To systematically review literature reporting changes in non-motor symptoms (NMS) among patients with advanced PD (APD) treated with levodopa/carbidopa intestinal gel (LCIG), deep brain stimulation (DBS), and continuous subcutaneous apomorphine infusion (CSAI).

Background: NMS are a major source of disability and poor quality of life (QoL) in PD. NMS Scale (NMSS) is a validated and widely-used tool to measure NMS with a published grading system for NMS burden. Improvement in NMSS score is an important dimension for evaluating holistic effectiveness with LCIG, DBS, or CSAI.

Methods: A systematic literature review was conducted in Ovid Medline, Embase, and the Cochrane database for articles published between 1/2003–5/2015. Data were extracted from non-case studies reporting any NMSS results for APD patients treated with LCIG, CSAI or DBS and meeting minimum sample-size thresholds. LCIG and CSAI studies with NMSS scores could be assessed for comparability; pooled sample size-weighted mean NMSS scores were compared at baseline and 6 months.

Results: Eight studies reported NMSS total scores at baseline and follow-up. Studies varied in duration (6–24 months) and sample size (15–172 patients). Mean age ranged from 59–68 years; 41–73% were male. Mean baseline total NMSS scores differed across studies (17.3–114.8). Patients on LCIG, CSAI, and DBS in almost all studies exhibited significantly improved total NMSS score from baseline to end of follow-up (LCIG: 18–56%, CSAI: 32–46%, DBS: 45%), majority of studies showed a reduced NMSS burden from very severe to severe. Pooled mean estimates for LCIG were similar to CSAI at baseline for sleep and urinary domains (17.15 vs 16.98, p=0.940 and 11.47 vs 9.07, p=0.194, respectively) but was significantly lower with LCIG versus CSAI at 6 months (8.03 vs 12.98, p=0.006 and 5.25 vs 7.93, p=0.047, respectively), suggesting greater improvement with LCIG.

Conclusions: APD patients on device-aided treatments in nearly all studies showed significantly improved total NMSS scores. Pooled estimates suggest LCIG may have a greater impact on sleep and urinary domains than CSAI; however, results should be interpreted carefully with further studies required for adjusted comparisons across all three treatments.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/non-motor-symptoms-in-advanced-parkinsons-disease-patients-treated-with-levodopacarbidopa-intestinal-gel-deep-brain-stimulation-or-continuous-subcutaneous-apomorphine-a-systematic-literature-revi/