Abstract
During the last decades, symptomatic treatment of motor symptoms of Parkinson’s disease (PD) improved continuously and is reflected by long-range independency of the patient during the disease course. However, advanced stages of PD still represent an important challenge to patients, caregivers and treating physicians. In patients with advanced PD, interventional therapy strategies are increasingly applied. These device-related treatment strategies using pump-based continuous dopaminergic stimulation (CDS) or deep brain stimulation (DBS) opened new treatment options especially if motor complications predominate. Well-designed clinical studies on these interventional therapeutic approaches provided class 1 evidence for the efficacy of DBS and CDS in advanced PD and opened new perspectives for their use in earlier disease stages also. Therefore, careful selection of patients amenable to the (semi)invasive therapy options becomes more and more important and requires an interdisciplinary setting that accounts for (i) optimal patient information and awareness, (ii) selection of best individual treatment modality, (iii) training of relatives and caregivers, (iv) management of complications, and (v) follow-up care. Here, we address these topics by summarizing current state-of-the-art in patient selection, providing specificities of treatment options and troubleshooting, and defining steps towards an optimized patient-centered care. Interventional therapies pioneer in the area of individualized treatment approaches for PD, and may be complemented in the future by biomarker-based improved stratification and by closed-loop systems for adaptive therapeutic strategies. In the present review, we summarize the proceedings of an Expert Workshop on Parkinson’s disease held on November 22, 2014 in Frankfurt, Germany.
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Acknowledgments
We thank G. Hipp for careful revision and valuable comments on the manuscript. Work of R.K. is funded by the National Research Fund, Luxembourg within the PEARL program (FNR/P13/6682797/Krüger) and the National Center for Excellence in Research—Parkinson’s disease (NCER-PD).
Conflict of interest
M. Hahne received remuneration for lectures and/or counseling services from the following companies: Desitin Pharma, Glaxo Smith-Kline GmbH & Co. KG, Orion Pharma, UCB Pharma. W.H. Jost received remuneration for lectures and/or counseling services from the following companies: Abbvie, Desitin Pharma, Medtronic, UCB Pharma, Zambon. Christian Winkler participated in advisory boards for Abbott, AbbVie, Orion Pharma GmbH and UCB. He received honoraria for talks from Abbott, AbbVie, Licher MT and UCB. C. Redecker received remuneration for lectures and/or counseling services from the following companies: Desitin Pharma, AbbVie Pharma, TEVA Pharma, Bayer Pharma, Novartis Pharma, Orion Pharma, UCB Pharma. P. Lingor received research support of the German Research Council (DFG), the Michael J Fox Foundation, the Else Kröner-Fresenius Foundation, as well as speaker’s honoraria and counseling remuneration from Abbvie and BayerVital. R. Krüger received research grants of the German Research Council (DFG; KR2119/8-1), the Michael J Fox Foundation, the German Federal Ministry for Education and Research (BMBF, COURAGE-PD, Mito-PD) and the Fond National de Recherche (FNR; PEARL and NCER-PD), Luxembourg, as well as speaker’s honoraria from Abbvie, B. Braun GmbH, St Jude Medical, and Medtronic. M.Lorrain received renumeration for lectures and/or counseling services from the following companies: Abbvie, Desitin Pharma, UCB Pharma, Medtronic, TEVA Pharma. Rüdiger Hilker has received speaker honoraria from Medtronic, Orion, GlaxoSmithKline, TEVA, Cephalon, Solvay, Desitin, Ipsen, Merz, Archimedes Pharma and Boehringer Ingelheim as well as travel funding from Medtronic, Allergan and Cephalon. He has served on a scientific advisory board for Cephalon and has received research funding from the Deutsche Parkinson Vereinigung (dPV), Bundesministerium für Bildung und Forschung and Goethe University Frankfurt.
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Krüger, R., Hilker, R., Winkler, C. et al. Advanced stages of PD: interventional therapies and related patient-centered care. J Neural Transm 123, 31–43 (2016). https://doi.org/10.1007/s00702-015-1418-0
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DOI: https://doi.org/10.1007/s00702-015-1418-0