The impact of motor fluctuations on the patient's quality of life

During the 97th Congress of the German Neurological Society an active interest in the field of movement disorders, particularly Parkinson's disease (PD), became evident with the corresponding sessions well-attended.

Parkinson's disease is the second most common neurodegenerative disease in Germany, with more than 400,000 people affected. It is the fastest-growing neurological disorder in the world, with the number of patients expected to double by 2040.

Patients with the disease will typically experience a range of motor symptoms during the course of their illness, with each symptom affecting a particular individual to a varying degree.

A major topic of this year's congress was motor complications and their frequency and management during the course of the disease. Disease progression is a major factor in the development of motor complications. Within 2-5 years, up to 50% of patients experience some degree of motor complications, and between 80 to 100% of PD patients will develop motor complications after 10 years of dopaminergic therapy. Many studies have investigated this issue and reported an increase of around 10% per year of treatment.

Impact of motor fluctuations

While in the early stages of the disease, with a disease duration of less than 6 years, the main impacting symptoms from a patient’s perspective are slowness of movement, tremors, and stiffness, in the advanced stage of the disease, motor fluctuations have the highest impact on daily activities and the patient’s quality of life, according to a recent study.

A patient’s fluctuating response to their medication can take a variety of forms, most commonly the predictable end-of-dose wearing-off, followed by dyskinesia as the second most common.

The fact that as the disease advances, the most troublesome issue that patients perceive is the lack of response to medication highlights the importance of precise symptom assessment and highly personalized management in the follow-up of patients.

Management of motor fluctuations

In the management of motor fluctuations, adjusting the timing and levels of levodopa doses can be crucial. Overall, lower doses of levodopa given more frequently are typically the best option for managing motor complications. However, with the progression of the disease, treatment options become more difficult, and advanced therapies such as subcutaneous apomorphine infusions, levodopa-gel infusion, or deep brain stimulation become the options.

During the congress also on-demand medication was discussed to manage unpredictable, persistent, or sudden off-episodes quickly and reliably. According to current studies, there is a great therapeutic need for easy-to-administer, well-tolerated, and effective on-demand medication, like, for example, subcutaneous and sublingual apomorphine or levodopa inhalation powder, and it should be considered earlier when patients experience motor fluctuations.

While we are seeing both oral medication and advanced therapies in use in Germany, we have observed that the objective measurement of motor symptoms is not widespread. Especially for the highly personalized management of the disease, detailed visibility of the patient’s even mildest symptoms is crucial for optimal symptom control and the avoidance of motor fluctuations in particular in the later stages of the disease.

Objective measurement technology can easily be used to complement the subjective evaluation using rating scales, such as the Unified Parkinson’s Disease Rating Scale (UPDRS). Together, they enable clinicians to make better-informed treatment decisions for their patients and prolong the effectiveness of medication.

We invite healthcare professionals and researchers to join us in embracing the future of data-driven PD management. By leveraging advanced technology and objective measurement methods, we can enhance patient outcomes, improve the quality of a patient’s life, and drive progress in the field of PD research and treatment.

Sources:

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