Journal of Neurology

, Volume 252, Issue 8, pp 926–935 | Cite as

Pharmacotherapy of Parkinson’s disease in Germany

  • J. C. Möller
  • Y. Körner
  • R. C. Dodel
  • C. Meindorfner
  • K. Stiasny-Kolster
  • A. Spottke
  • H. P. Krüger
  • W. H. Oertel
ORIGINAL COMMUNICATION

Abstract

Treatment standards or guidelines have been developed for most features of Parkinson’s disease (PD). However, data on the actual treatment that is put into practice are scarce. In 2000, a nationwide survey on the topic of sudden onset of sleep (SOS) in PD was initiated among the members of the German patient support group (deutsche Parkinson–Vereinigung, dPV). A part of this mailed questionnaire survey covering the antiparkinsonian and concomitant medication of the participants is presented here. This study analyses data sets from more than 6,500 PD patients. The mean dopaminergic dose was equivalent to 599 ± 387 mg levodopa/die. The most frequently administered drugs were levodopa (94.2 %), dopamine agonists (DA) (71.7 %), amantadine (40.1 %), selegiline (27.6 %), entacapone (20.4 %), budipine (12.3 %), and anticholinergics (11.8 %). Costs of pharmacotherapy were estimated to be approximately € 399 million/year in Germany. PD drug therapy in general strongly depended on age, disease duration, and the level of care. The treatment guidelines were apparently not consistently followed underlining the need for their continuous propagation throughout the medical community. In addition our data suggest that non–motor symptoms in PD are not adequately treated and that concomitant sedative medication contributes to the occurrence of SOS.

Key words

levodopa dopamine agonist sleep attack depression 

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References

  1. 1.
    Askmark H, Antonov K, Aquilonius SM (2003) The increased utilisation of dopamine agonists and the introduction of COMT inhibitors have not reduced levodopa consumption–a nation-wide perspective in Sweden. Parkinsonism Relat Disord 9:271–276PubMedGoogle Scholar
  2. 2.
    Brandstädter D, Oertel WH (2003) Depression in Parkinson’s disease. Adv Neurol 91:371–381PubMedGoogle Scholar
  3. 3.
    Dodel RC, Berger K, Oertel WH (2001) Health-related quality of life and healthcare utilisation in patients with Parkinson’s disease: impact of motor fluctuations and dyskinesias. Pharmacoeconomics 19:1013–1038PubMedGoogle Scholar
  4. 4.
    Dodel RC, Singer M, Köhne-Volland R, Szucs T, Rathay B, Scholz E, Oertel WH (1998) The economic impact of Parkinson’s disease. An estimation based on a 3-month prospective analysis. Pharmacoeconomics 14:299–312PubMedGoogle Scholar
  5. 5.
    Donnan PT, Steinke DT, Stubbings C, Davey PG, MacDonald TM (2000) Selegiline and mortality in subjects with Parkinson’s disease. Neurology 55:1785–1789PubMedGoogle Scholar
  6. 6.
    Hoehn MM, Yahr MD (1967) Parkinsonism: onset, progression and mortality. Neurology 17:427–442PubMedGoogle Scholar
  7. 7.
    Bundesverband der pharmazeutischen Industrie (2000) Rote Liste. Rote Liste Verlag, WeinheimGoogle Scholar
  8. 8.
    Johns MW (1991) A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep 14:540–545PubMedGoogle Scholar
  9. 9.
    Körner Y, Meindorfner C, Möller JC, Stiasny-Kolster K, Haja D, Cassel W, Oertel WH, Krüger HP (2004) Predictors of sudden onset of sleep. Mov Disord 19:1279–1284PubMedGoogle Scholar
  10. 10.
    Leoni O, Martignoni E, Cosentino M, Michielotto D, Calandrella D, Zangaglia R, Riboldazzi G, Oria C, Lecchini S, Nappi G, Frigo G (2002) Drug prescribing patterns in Parkinson’s disease: a pharmacoepidemiological survey in a cohort of ambulatory patients. Pharmacoepidemiol Drug Saf 11:149–157PubMedGoogle Scholar
  11. 11.
    LePen C, Wait S, Moutard-Martin F, Dujardin M, Ziegler M (1999) Cost of illness and disease severity in a cohort of French patients with Parkinson’s disease. Pharmacoeconomics 16:59–69PubMedGoogle Scholar
  12. 12.
    Lienert GA, Krauth J (1974) Die Konfigurationsanalyse. IX. Auswertung multivariater klinischer Untersuchungspläne (Teil 1). Zeitschr Klin Psychol Psychother 22:3–17Google Scholar
  13. 13.
    Lozano AM, Lang AE, Galvez-Jimenez N, Miyasaki J, Duff J,Hutchinson WD, Dostrovsky JO (1995) Effect of GPi pallidotomy on motor function in Parkinson’s disease. Lancet 346: 1383–1387CrossRefPubMedGoogle Scholar
  14. 14.
    Meissner W, Trottenberg T, Klaffke S, Paul G, Kuhn AA, Arnold G, Einhäupl KM, Kupsch A (2001) Apomorphine therapy versus deep brain stimulation. Clinical and economic aspects in patients with advanced Parkinson’s disease. Nervenarzt 72:924–927CrossRefPubMedGoogle Scholar
  15. 15.
    Moro E, Scerrati M, Romito LMA, Roselli R, Tonali P, Albanese A (1999) Chronic subthalamic nucleus stimulation reduces medication requirements in Parkinson’s disease. Neurology 53:85–90PubMedGoogle Scholar
  16. 16.
    Klinische “Leitlinien” der Deutschen Gesellschaft für Neurologie (2003) Leitlinien für Diagnostik und Therapie in der Neurologie. Thieme, StuttgartGoogle Scholar
  17. 17.
    Oertel WH, Quinn N (2002) Parkinsonism. In: Brandt T, Diener HC, Caplan LR (eds) Neurological disorders: course and treatment. Academic Press, San Diego, pp 1021–1079Google Scholar
  18. 18.
    Oertel WH, Quinn NP (1996) Parkinsonism. In: Brandt T, Caplan LR, Dichgans J, Diener HC, Kennard C (eds) Neurological Disorders – Course and Treatment. Academic Press, San Diego, pp 715–772Google Scholar
  19. 19.
    Olanow CW, Watts RL, Koller WC (2001) An algorithm (decision tree) for the management of Parkinson’s disease: treatment guidelines. Mov Disord 56:S1–S88Google Scholar
  20. 20.
    Pfeiffer RF (2003) Gastrointestinal dysfunction in Parkinson’s disease. Lancet Neurol 2:107–116PubMedGoogle Scholar
  21. 21.
    Schwabe U (2001) Parkinsonmittel. In: Schwabe U, Paffrath D (eds) Arzneiverordnungsreport 2001. Springer, Berlin, pp 591–596Google Scholar
  22. 22.
    Shabnam GN, Th C,Kho D, H R, Ce C (2003) Therapies for depression in Parkinson’s disease. Cochrane Database Syst Rev:CD003465Google Scholar
  23. 23.
    Siddiqui MF, Rast S, Lynn MJ, Auchus AP, Pfeiffer RF (2002) Autonomic dysfunction in Parkinson’s disease: a comprehensive symptom survey. Parkinsonism Relat Disord 8:277–284PubMedGoogle Scholar
  24. 24.
    Singer C (1998) Urinary dysfunction in Parkinson’s disease. Clin Neurosci 5:78–86CrossRefPubMedGoogle Scholar
  25. 25.
    Singer C, Weiner WJ, Sanchez-Ramos JR (1992) Autonomic dysfunction in men with Parkinson’s disease. Eur Neurol 32:134–140PubMedGoogle Scholar
  26. 26.
    Slaughter JR, Slaughter KA, Nichols D, Holmes SE, Martens MP (2001) Prevalence, clinical manifestations, etiology, and treatment of depression in Parkinson’s disease. J Neuropsychiatry Clin Neurosci 13:187–196PubMedGoogle Scholar
  27. 27.
    Spottke EA, Martin R, Berger K, Machat O, Oertel WH, Dodel RC (2002) Healthcare utilization and economic impact of Parkinson’s disease. Mov Disord 17(Suppl 5):S142Google Scholar
  28. 28.
    Spottke EA, Reuter M,Machat B, Bornschein B, Campenhausen S, Berger K, Koehne-Volland RK, Rieke J, Simonow A, Brandstädter D, Siebert U, Oertel WH, Dodel RD. Cost of illness and its predictors for Parkinson’s disease in Germany. Pharmacoeconomics: in pressGoogle Scholar

Copyright information

© Steinkopff-Verlag 2005

Authors and Affiliations

  • J. C. Möller
    • 1
  • Y. Körner
    • 2
  • R. C. Dodel
    • 3
  • C. Meindorfner
    • 2
  • K. Stiasny-Kolster
    • 1
  • A. Spottke
    • 3
  • H. P. Krüger
    • 2
  • W. H. Oertel
    • 1
  1. 1.Dept. of NeurologyPhilipps-Universität MarburgMarburgGermany
  2. 2.Centre for Traffic SciencesJulius-Maximilians-UniversityWürzburgGermany
  3. 3.Dept. of NeurologyRheinische Friedrich-Wilhelms-UniversityBonnGermany

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