PracticeUpdate Conference Series - ANZAN 2018

" Of patients with

Parkinson’s disease eligible for device-

A total of 100 patients were recruited in Australia. Of these, 61% (95% CI 51.4– 70.6%) were diagnosed with advanced Parkinson’s disease by physician judgment. Patients were 66.6 ± 8.5 years of age, 65% were male, were living at home (97%), and had been diagnosed a median 10.7 (0–30.5) years prior. Motor fluctuations were present in 68%. Those with advanced Parkinson’s disease were referred predominantly to enable access to device-assisted therapy (49%). Patients without advanced Parkinson’s disease were referred largely for diagnos- tic purposes (41%). Referral to a movement disorder clinic occurred a median of 4.8 years following diagnosis of advanced Parkinson’s disease and 3.6 years for patients without Parkinson’s mimics. Although 62% were eligible for device- assisted therapy, only two-thirds of these patients received them. The most commonly used dopamine agonist therapy was deep brain stimulation (64.3%). Only fair agreement between physician’s judgment and the criteria for advanced Parkinson’s disease by Delphi method (Cohen’s kappa) was observed: 0.325 (95% CI 0.150–0.500). Drs. Fung and Williams concluded that the definition of advanced Parkinson’s disease needs to be refined to facilitate greater agreement among movement disorder specialists. Of patients with Parkinson’s disease eligi- ble for device-assisted therapy, one-third remain untreated. Australian practice is weighted toward deep brain stimulation. assisted therapy, one- third remain untreated. Australian practice is weighted toward deep brain stimulation. "

The cross-sectional, noninterventional observational OBSERVE-PD study was performed in movement disorder clinics from 18 countries. Drs. Fung and Williams reported results from the Australian cohort. Participants included consecutive adults with Parkinson’s disease attending a routine clinical visit, or inpatients at partic- ipating clinical sites, and who could speak English. The primary outcome measure was the proportion of patients diagnosed with advanced Parkinson’s disease by physician judgment. Secondary objectives included: ƒ ƒ Evaluation of clinical characteristics of advanced vs nonadvanced Parkinson’s disease ƒ ƒ Assessment of the percentage of patients with advanced Parkinson’s disease considered for device-aided therapies ƒ ƒ Exploration of referral practices in advanced Parkinson’s disease ƒ ƒ Comparison of the percentage of cases of advanced Parkinson’s disease identified in routine clinical practice by physician’s judgment to advanced Parkinson’s disease identified based on criteria for advanced Parkinson’s dis- ease derived using the Delphi method.

within the presupplementary motor area and disrupted signaling between the presupplementary motor area and sub- thalamic nucleus. A hyperdirect pathway was implicated in the generation of doorway freezing in Parkinson’s disease. Dr. Lewis told Elsevier’s PracticeUpdate , “Understanding the neural basis for freez- ing in these different situations should allow us to target novel therapies. Already, we are running the same virtual reality paradigm in patients while they undergo deep brain stimulation. In this setting of a feedback system, we get to “listen in” to the brain and determine whether a firing signal might respond to treatment.” Dr. Matar said, “The study overall was a proof of concept that virtual environments can be a valuable tool for investigating the neural bases of what we traditionally thought of as less accessible symptoms in a variety of neurological diseases.” Victor S.C. Fung, PhD, FRACP, of the University of Sydney, David Williams, MD, of Monash University in Melbourne, Victoria, Australia, and colleagues set out to characterize patients with advanced Parkinson’s disease seen in movement disorder clinics. They evaluated the proportion of patients with Parkinson’s disease who were iden- tified as suffering from advanced disease.

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ANZAN 2018 • PRACTICEUPDATE CONFERENCE SERIES 19