Objective: To identify reasons for medication changes at outpatient movement disorder clinics and determine outcome of these changes at next clinic visit.

Background: Parkinson’s disease (PD) is primarily managed through specialist outpatient clinical care, with patients being reviewed every 6-12 months. Due to the complex and progressive nature of PD, medication changes are needed throughout the course of the disease to address progression and development of additional symptoms. Stepwise use of the various dopaminergic enhancing therapeutics remains the mainstay of PD pharmacotherapy, but adjunct use of medications to address non-motor symptoms (NMS) adds another layer of complexity to the management of PD.

Methods: A review of medication changes in PD patients was carried out by retrospective chart review of patients attending a tertiary referral PD clinic over a 6 month period from January 2014 to July 2014. Records were reviewed to gather data on baseline symptoms, medications, subsequent changes to medications and the reason for that change. Further data was gathered from the subsequent clinic visit to determine the outcome of any medication changes that were made. All records were accessed through internal electronic patient records.

Results: A total of 160 PD patients were reviewed, with 57% Male and 43% female, mean age 67. The mean time to follow-up was 8 months. 97 (61%) patients had changes made to their medication, of which 42 (43%) were made to address motor symptoms, 40 (41%) for NMS, and 15 (16%) for both motor symptoms and NMS. On review of patient’s symptoms at the subsequent clinic visit, 40 (41%) had improved, 30 (31%) had deteriorated and 27 (28%) had remained the same clinically.

Conclusions: From this review it is clear that medication changes and adjustments in PD outpatient clinics are not adequately addressing progressive and new onset symptoms. While normal disease progression must be taken into account, especially with regard to motor symptoms, there is scope to improve outpatient management of NMS. More objective measures of disease progression would allow for better outcome measures. Disease severity scales such as the unified Parkinson’s disease rating scale (UPDRS) can be used to monitor overall disease activity, but are not carried out routinely at clinics due to time constraints.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/outpatient-management-of-parkinsons-disease-a-review-of-medication-changes-made-to-address-both-motor-and-non-motor-symptoms/