Objective: To evaluate the use of the 19-items Wearing off Questionnaire (WOQ-19) to detect fluctuations in patients with non-advanced Parkinson’s disease (PD) and to evaluate the response to clinical management.

Background: The onset of Fluctuations in PD is related to severity, duration of the disease and total dose of levodopa (1,2). Fluctuations can appear during the first years and have a negative impact on the quality of life (5). Questionnaires such as WOQ-19 have been shown to be better than anamnesis to detect early fluctuations (3,4). WOQ-19 may be useful for the clinical management of early fluctuations.

Method: Patients with idiopathic PD without fluctuations or dyskinesia, who expressed complaints about poor control of their symptoms, were consecutively selected.A detailed anamnesis was performed in search of motor or non-motor fluctuations. The WOQ-19 was performed in all patients. When fluctuations were detected, a treatment adjustment was made according to the usual clinical practice and the patient’s characteristics. Three months later patients where re-evaluated using WOQ-19

Results: A total of 32 patients (14 women) were included. They had a mean age of 72 years (± 7.3), mean duration disease was 5.8 years (± 2.65). Mean H&Y was 2 (± 0.4). Anamnesis was positive in 4 patients (12%), negative in 29 cases (87%). WOQ-19 detected fluctuations in 18 patients (54%). An average of 3 fluctuating symptoms per patient was detected. Motor fluctuations were more frequent than non-motor fluctuations (42 vs.13). The detection of fluctuations led to a modification of the treatment in 16 patients (50%). (ICOMT (3), Safinamide (10), or more levodopa (3) was added). In 10 patients 62.5% total or partial control of fluctuations was achieved. In 4 patients there was no improvement.

Conclusion: In our experience, the systematic use of WOQ-19 increased the detection of fluctuations by 50%, as described by other authors. In our experience of clinical practice, the increased detection of early fluctuations improved the clinical management of our patients. We think that the use of these questionnaires improves the management of patients with non-complex Parkinson’s, but more evidence is needed to adopt a consensus like this.

References: 1. Warren Olanow C, Kieburtz K, Rascol O, Poewe W, Schapira AH, Emre M, et al. Factors predictive of the development of Levodopa-induced dyskinesia and wearing-off in Parkinson’s disease. Mov Disord.(2013) 28:1064–71. 2. Cilia R, Akpalu A, Sarfo FS, Cham M, Amboni M, Cereda E, et al. The modern pre-levodopa era of Parkinson’s disease: insights into motor complications from sub-Saharan Africa. Brain. 2014;137:2731–2742. 3. Martinez-Martin P, Tolosa E, Hernandez B, Badia X. Validation of the ‘‘QUICK’’ questionnaire—a tool for diagnosis of ‘‘wearing- off’’ in patients with Parkinson’s disease. Mov Disord. 2008;23: 830–836. 4. A. Antonini, P. Martinez-Martin, R. K. Chaudhuri et al., “Wearing-off scales in Parkinson’s disease: critique and recommendations,” Movement Disorders, vol. 26, no. 12, pp. 2169–2175, 2011. 5. Stocchi F, Antonini A, Barone P, et al. Early detection of wearing off in Parkinson disease: The DEEP study. Parkinsonism Relat Disord 2014;20:204-211.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/clinical-management-of-incipient-wearing-off-with-the-19-items-wearing-off-questionnaire-woq-19/