Objective: To describe a home-based method for improved Parkinson’s therapy titration.

Background: Many patients with Parkinson’s disease, due to the location of their residence or inability to travel, do not have access to a movement disorders specialist.  Those who do have access typically see their neurologist no more than every six months.  Standard therapy titration relies on a repeated process of clinical assessment at the office and patient interviews. For many patients, this infrequent interaction with their treating physician means that they endure suboptimal treatments for extended periods.  A new method for quickly coming to a quantitative evaluation of different titration regimens could be very helpful for patients.  Having multiple quantitative evaluations performed by the patient at home may save the physician time and improve patient outcomes, thus making the process more efficient.

Methods: Motor symptoms can be evaluated at home, multiple times per day, using a quantitative system of motion sensors, smartphone/tablet, and an electronic diary, without requiring the presence of a clinician. In this system, severity scores for tremor, bradykinesia, gait, and dyskinesia are calculated on a 0-4 scale and presented to a clinician remotely over a secure web interface. The system is prescribed and mailed to patients who use the device over the course of a month. Specifically, patients are requested to use the device for three days before coming to see their treating physician for a therapy adjustment. After the new therapy regimen is implemented, the patient again uses the system for three days. Subsequently, phone calls are scheduled as necessary for remote therapy adjustments. The process is repeated for up to four weeks to determine a therapy regimen that optimizes symptoms with minimal side effects (e.g., dyskinesia).

Results: Preliminary observations suggest patients and clinicians are able and willing to use the remote assessment technology and that the remotely collected data can be used to help with the therapy titration process.

Conclusions: Therapy adjustments based in part on remote quantitative motor assessment may help improve the efficiency of therapy titration, thereby saving time and cost. This will reduce the time patients spend on suboptimal therapy regimens and improve quality of life.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/wearable-sensor-based-therapy-titration-for-parkinsons-disease/