Objective: To assess socio-demographic and disease specific data in patients with Parkinson’s disease (PD) before and one year after therapy escalation with subcutaneous apomorphine (APO), levodopa-carbidopa intestinal gel (LCIG) and deep brain stimulation (DBS) utilizing a questionnaire.

Background: When oral medication fails to adequately control motor fluctuations in PD patients, DBS, APO, and LCIG are escalation options to optimize therapy. However, explicit guidelines, which therapy might be suitable for which patient lack.

Methods: Between May 2014 and January 2015 we conducted a regional survey in Berlin/Brandenburg, Germany utilizing a newly designed assessment sheet. We systematically registered patients undergoing therapy escalation due to poorly controlled motor fluctuation and compared socio-demographic, disease specific data and current oral medication between groups at the time of therapy escalation. The one year follow-up will look at changes of disease specific data and concurrent oral medication.

Results: We included 38 patients in our survey, of which 16 received APO, 14 DBS and 8 LCIG. In comparison to APO and LCIG, DBS patients were younger (DBS 62years [41-75], APO 73 [47-82], LCIG 71 [67-79]; p=0.04; median ⦥) and had shorter disease duration at the time of therapy escalation (DBS 10years [6-20], APO 14 [3-30], LCIG 13 [6-34]; p=0.02). UPDRS-III scores in the ON-state did not differ between groups. LCIG patients showed more cognitive impairment and psychotic symptoms than APO and DBS. Patients undergoing DBS had less severe response fluctuations compared to those treated with pumps (MDS-UPDRS IV scores for DBS 6 [0-19], APO 12 [9-19], LCIG 12 [11-17]; p<0.01; median ⦥).

Conclusions: In this real life survey, various individual factors (i.e. psychiatric complications, age, severity of fluctuations, etc.) had an impact on the choice of the type of therapy escalation. Younger age and lower severity of response fluctuations in DBS vs. pump-treatments may reflect increased propensity to perform DBS at an earlier disease stage as suggested by the Early Stim trial (Schuepbach et al. NEJM 2013).

Preliminary results were presented at the Deutsche Parkinson Gesellschaft Conference 2015 in Berlin, Germany.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/therapy-escalation-in-parkinsons-disease-the-temp-trial-a-regional-survey/