Objective: This study sought to understand the continuing medical education (CME) needs of US-practicing neurologists (NEUROs) and neurology advanced practice providers (APPs) in managing patients with Parkinson’s Disease (PD) experiencing OFF episodes by assessing current approaches to management.

Background: As PD progresses, patients experience OFF episodes between medication doses, when symptoms return unpredictably and/or for longer duration. Given the emergence of newer therapies to manage OFF episodes, it is imperative clinicians assess for and devise treatment approaches with their patients to manage these episodes.

Method: An online survey including two patient case scenarios was developed to assess current approaches to managing OFF episodes and knowledge of newer therapies. The survey was fielded by email in December 2021.

Results: Respondents included neurology APPs (N = 34) and NEUROs (N = 102), with a subset of movement disorder specialists (MDSs; n = 34). Most respondents reported that they evaluate their patients with PD for OFF episodes at every visit; however, general NEUROs reported lower likelihood to use a rating scale to assess OFF episodes as compared to neurology APPs and MDSs.

There was little consensus in approach or preference for treating OFF episodes in the cases presented. In selecting an adjunctive therapy, respondents were divided across a COMT inhibitor, a dopamine agonist, or an on-demand medication. The potential for side effects and efficacy of therapy were rated as top factors in therapy selection. Psychiatric effects (e.g., from dopamine agonists) were rated as the most significant potential side effect to influence treatment approach. 
Most were able to identify the mechanism of action (MoA) of apomorphine, istradefylline, and opicapone, but fewer identified the MoA of amantadine or tavapadon. Respondents reported high likelihood to participate in CME on PD in the coming year and are interested in topics including a comparison of newer treatments, managing nonmotor PD symptoms, and managing OFF episodes.

Conclusion: This study shows variability in approach to managing OFF episodes as clinicians balance concerns for potential side effects and efficacy of therapies. Given therapeutic developments in managing OFF episodes, CME presenting case scenarios and evidence-based management approaches continues to be needed to address gaps.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/understanding-the-continuing-educational-needs-of-us-clinicians-managing-off-episodes-in-parkinsons-disease/