Objective: To evaluate the use of the PKG to aid clinical management decisions in a district general hospital.

Background:  

Clinicians treating Parkinson’s disease (PD) must rely on the information patients provide of their day to day symptoms, combined with clinical findings at that moment in time, to guide treatment decisions.

The PKG is a graphical depiction or movement recording of a patient with PD, depicting dyskinesia, bradykinesia, periods of immobility and timings of medication use.

Methods: Patients were identified as inpatients or at clinic appointments. Where possible, patients were also asked to complete a 7 day symptom diary and record the timings of all medications. Patients wore the device for 7 days and medication reminder times for their dopamine containing medications were set.

We enrolled 25 patients as part of a preliminary study, and have thus far evaluated 10 cases with subsequent follow up. 

Results: In 2 patients with early stage disease bradykinesia was over reported by PKG, as on clinical assessment and with patient diaries there was no reported bradykinesia.

1 patient who felt under treated was identified as having significant periods of dyskinesia, and PKG report was used to explain he was in fact over treated.

1 patient who had reported freezing episodes was found to have significant episodes of bradykinesia, PKG helped guide apomorphine use.

In 3 patients with advanced disease PKG showed significant bradykinesia, 1 patient had previously declined increase in medication dose and subsequently was persuaded to comply following PKG study. 1 of these patients had recurrent erroneous activation of the medication sensor, which may reflect impulse control disorder. 1 patient with cognitive impairment failed to report his bradykinesia which was detected by PKG.

Conclusions: PKG can act as a medication prompt for patients with underlying cognitive impairment, although currently only one medication can be programmed.

The use of PKG recording in patients with less severe disease ( Hohn and Yahr stages 1-2) may over estimate bradykinesia. Patients with congnitive impairment may under report their symptoms, and PKG can aid in assessing unreported symptoms.

Initial study shows the use of PKG, when used in conjunction with clinical assessment and patient symptom diaries, may be beneficial in the management of patients with PD and needs to be further evaluated.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/does-parkinsons-kinetigraph-pkg-recording-help-in-clinical-decision-making-a-local-experience/