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Supervised versus unsupervised technology-based levodopa monitoring in Parkinson’s disease: an intrasubject comparison

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Abstract

We aimed to assess the intrasubject reproducibility of a technology-based levodopa (LD) therapeutic monitoring protocol administered in supervised versus unsupervised conditions in patients with Parkinson’s disease (PD). The study design was pilot, intrasubject, single center, open and prospective. Twenty patients were recruited. Patients performed a standardized monitoring protocol instrumented by an ad hoc embedded platform after their usual first morning LD dose in two different randomized ambulatory sessions: one under a physician’s supervision, the other self-administered. The protocol is made up of serial motor and non-motor tests, including alternate finger tapping, Timed Up and Go test, and measurement of blood pressure. Primary motor outcomes included comparisons of intrasubject LD subacute motor response patterns over the 3-h test in the two experimental conditions. Secondary outcomes were the number of intrasession serial test repetitions due to technical or handling errors and patients’ satisfaction with the unsupervised LD monitoring protocol. Intrasubject LD motor response patterns were concordant between the two study sessions in all patients but one. Platform handling problems averaged 4% of total planned serial tests for both sessions. Ninety-five percent of patients were satisfied with the self-administered LD monitoring protocol. To our knowledge, this study is the first to explore the potential of unsupervised technology-based objective motor and non-motor tasks to monitor subacute LD dosing effects in PD patients. The results are promising for future telemedicine applications.

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Acknowledgements

Grant no. 451bis/2015 from “Fondazione del Monte di Bologna e Ravenna” is gratefully acknowledged. We thank the patients who participated in the study for their active cooperation. This study was presented at the 18th Annual Congress of the Italian Society of Clinical Movement Analysis (SIAMOC), Politecnico di Torino, Turin, Italy, 4th–7th October 2017. Anne Collins edited the English text.

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Authors and Affiliations

  1. Laboratory of Clinical Neuropharmacology, Neurology Clinic, IRCCS-Institute of Neurological Sciences of Bologna, Via Altura 1/8, 40139, Bologna, Italy

    Giovanna Lopane, Pietro Cortelli, Giovanna Calandra-Buonaura & Manuela Contin

  2. Personal Health Systems Lab, Department of Electrical, Electronic, and Information Engineering, University of Bologna, Bologna, Italy

    Sabato Mellone, Mattia Corzani & Lorenzo Chiari

  3. Health Sciences and Technologies-Interdepartmental Center for Industrial Research, University of Bologna, Bologna, Italy

    Lorenzo Chiari

  4. Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy

    Pietro Cortelli, Giovanna Calandra-Buonaura & Manuela Contin

Authors
  1. Giovanna Lopane
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  2. Sabato Mellone
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  3. Mattia Corzani
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  4. Lorenzo Chiari
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  5. Pietro Cortelli
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  6. Giovanna Calandra-Buonaura
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  7. Manuela Contin
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Corresponding author

Correspondence to Manuela Contin.

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Conflicts of interest

G. Lopane and M. Corzani received a Grant from “Fondazione del Monte di Bologna e Ravenna” (Grant no. 451bis/2015). The other authors declare that they have no conflict of interest.

Ethical standards

The study was approved by the Ethics Committee of the Bologna-Imola Local Health Trust (Protocol number 15111) and was performed in accordance with the ethical standards of the Declaration of Helsinki and its later amendments. Patients gave their written informed consent to study participation.

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Lopane, G., Mellone, S., Corzani, M. et al. Supervised versus unsupervised technology-based levodopa monitoring in Parkinson’s disease: an intrasubject comparison. J Neurol 265, 1343–1352 (2018). https://doi.org/10.1007/s00415-018-8848-1

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  • DOI: https://doi.org/10.1007/s00415-018-8848-1

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