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Developing consensu...
Developing consensus among movement disorder specialists on clinical indicators for identification and management of advanced Parkinson’s disease : a multi-country Delphi-panel approach
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- Antonini, Angelo (författare)
- University of Padova
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- Stoessl, A. Jon (författare)
- Pacific Parkinson's Research Institute
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- Kleinman, Leah S. (författare)
- Evidera Ltd
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- Skalicky, Anne M. (författare)
- Evidera Ltd
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- Marshall, Thomas S. (författare)
- AbbVie Inc.
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- Sail, Kavita R. (författare)
- AbbVie Inc.
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- Onuk, Koray (författare)
- AbbVie Inc.
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- Odin, Per Lars Anders (författare)
- Lund University,Lunds universitet,Restorative Parkinson Unit,Forskargrupper vid Lunds universitet,Lund University Research Groups
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(creator_code:org_t)
- 2018-08-20
- 2018
- Engelska.
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Ingår i: Current Medical Research and Opinion. - : Informa UK Limited. - 0300-7995 .- 1473-4877. ; 34:12, s. 2063-2073
- Relaterad länk:
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http://dx.doi.org/10...
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https://www.tandfonl...
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https://lup.lub.lu.s...
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https://doi.org/10.1...
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Abstract
Ämnesord
Stäng
- Background: Lack of a global consensus on the definition of advanced Parkinson’s disease (APD) and considerations for timing of device-aided therapies may result in heterogeneity in care. Objectives: To reach consensus among movement disorder specialists regarding key patient characteristics indicating transition to APD and guiding appropriate use of device-aided therapies in the management of PD symptoms. Methods: A Delphi-panel approach was utilized to synthesize opinions of movement disorder specialists and build consensus. Results: A panel was comprised of movement disorder specialists from 10 European countries with extensive experience of treating PD patients (mean =24.8 ± 7.2 years). Consensus on indicators of suspected APD and eligibility for device-aided therapies were based on motor symptoms, non-motor symptoms, and functional impairments. Key indicators of APD included: (i) motor—moderate troublesome motor fluctuations, ≥1 h of troublesome dyskinesia/day, ≥2 h “off” symptoms/day, and ≥5-times oral levodopa doses/day; (ii) non-motor—mild dementia, and non-transitory troublesome hallucinations; (iii) functional impairment—repeated falls despite optimal treatment, and difficulty with activities of daily living. Patients with good levodopa response, good cognition, and <70 years of age were deemed as good candidates for all three device-aided therapies. Patients with troublesome dyskinesia were considered good candidates for both levodopa-carbidopa intestinal gel and Deep Brain Stimulation (DBS). PD patients with levodopa-resistant tremor were considered good candidates for DBS. Conclusion: Identifying patients progressing to APD and suitable for device-aided therapies will enable general neurologists to assess the need for referral to movement disorder specialists and improve the quality of care and patient outcomes.
Ämnesord
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Neurologi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Neurology (hsv//eng)
Nyckelord
- Continuous subcutaneous apomorphine infusion (CSAI)
- Deep brain stimulation (DBS)
- Delphi technique
- Dyskinesia
- Levodopa-Carbidopa Intestinal Gel (LCIG)
- Motor fluctuations
- Parkinson disease
- Patient identification
- Wearing-off
Publikations- och innehållstyp
- art (ämneskategori)
- ref (ämneskategori)
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