Home > News > Beyond Motor Symptoms – Impact of Continuous Dopaminergic Stimulation on Non-motor and Social Aspects of Advanced Parkinson’s Disease
Movement Disorders, Parkinson's Disease
Read Time: 2 mins

Beyond Motor Symptoms – Impact of Continuous Dopaminergic Stimulation on Non-motor and Social Aspects of Advanced Parkinson’s Disease

Published Online: July 15th 2012 European Neurological Review, 2012;7(Suppl. 1):17–9 DOI: http://doi.org/10.17925/ENR.2012.07.S1.17
Authors: Barbara Pickut
Quick Links:
Abstract
Article
Article Information
Abstract:
Overview

Two patient cases are presented here that illustrate the benefits of continuous dopaminergic stimulation on the non-motor symptoms of Parkinson’s disease. In both cases, levodopa/carbidopa intestinal gel infusion therapy led to improvements in anxiety, depression, concentration, urge incontinence, sexual function, sleep, vivid dreams and rapid eye movement sleep behaviour disorder, pain, sweating and feelings of self-assuredness. Such improvements have an impact on patients’ quality of life and can help their social functioning.

Keywords

Parkinson’s disease, levodopa, continuous dopaminergic stimulation, non-motor symptoms, quality of life

Article:

The non-motor symptoms (NMS) of Parkinson’s disease (PD) are common and often not fully appreciated. They are sometimes referred to as non-dopaminergic symptoms, which in some cases may be a misnomer. NMS are present at all stages of the disease, and are potentially a major source of disability. Some of these symptoms, such as dementia, delirium, hallucinations, and psychosis, are important factors in PD patients’ lives and may lead to institutionalisation. As such, they affect not only the individual but also have a social impact.

It is encouraging that the non-motor features of PD have been incorporated into the American Academy of Neurology (AAN) PD quality measures published in 2010,1 as healthcare stakeholders use these measures when making decisions on the allocation of healthcare resources. Out of the 10 AAN quality measures, five concern the non-motor features of PD (see Box 1).

The following two case reports illustrate the impact of continuous dopaminergic stimulation (CDS) on the NMS and social aspects of PD.

Case Report 1
Patient 1, a 57-year-old male family physician, had been diagnosed with PD at the age of 45. After 12 years of PD, his daily regimen was 800 mg levodopa (spread over seven intakes) plus 100 mg levodopa-benserazide hydrodynamically balanced system (HBS). He also took 200 mg tolcapone (three times a day), 100 mg amantadine (twice daily), 1 mg rasagiline (once daily) and 150 mg venlafaxine (once daily).

The patient’s motor complications included troublesome dyskinesias, end-of-dose ‘wearing off’, unpredictable ‘on-off’ motor fluctuations, dose failures and delayed ‘on’. His non-motor complications comprised depression, free-floating anxiety, concentration problems, sleep dysfunction, autonomic dysfunction (urinary urgency), sensory dysfunction (hyposmia and pain) and sexual dysfunction (erectile dysfunction and libido loss). The patient’s family was concerned that he might become dyskinetic or drop into a deep ‘off’ when he was outside the home. The NMS were also very troublesome for the patient professionally, with his patients beginning to question his competency. The combination of motor and non-motor complications led him to a forced early retirement and the patient’s social and family life were adversely affected.

To obtain reimbursement from the Belgian authorities for levodopa/carbidopa intestinal gel (LCIG) infusion, a test week is required. The patient completed a test week in November 2009, and in March 2010 approval was obtained to initiate LCIG infusion therapy. All other Parkinson’s medications were stopped. Hisdosages during the first year of LCIG infusion therapy were fairly stable (see Table 1).

To view the full article in PDF or eBook formats, please click on the icons above.

Article Information:
Disclosure

Barbara Pickut serves on advisory boards for Boehringer Ingelheim, GlaxoSmithKline, Abbott (Solvay) Pharmaceuticals and UCB, and has received research grants from Boehringer Ingelheim.

Correspondence

Barbara Pickut, University Hospital Antwerp (UZA), Department of Neurology, Wilrijkstraat 10, 2650 Edegem, Belgium. E: barbara.pickut@ua.ac.be

Support

The V International Forum on Parkinson’s Disease (Helsinki, Finland, 6–7 May 2011) was funded by an unrestricted educational grant from Abbott. Abbott funded the development of this supplement by ESP Bioscience (Crowthorne, UK). Emily Chu and Nicole Meinel of ESP Bioscience provided medical writing and editorial support to the author in the development of this publication. Abbott had the opportunity to review and comment on the publication’s content; however, all decisions regarding content were made by the author.

Received

2013-06-22T00:00:00

References

  1. Cheng EM, Tonn S, Swain-Eng R, et al., Quality improvement in neurology: AAN Parkinson disease quality measures: report of the Quality Measurement and Reporting Subcommittee of the American Academy of Neurology, Neurology, 2010;75:2021–7.
  2. Chaudhuri KR, Healy DG, Schapira AH, Non-motor symptoms of Parkinson’s disease: diagnosis and management, Lancet Neurol, 2006;5:235–45.
  3. Schenck CH, Bundlie SR, Mahowald MW, Delayed emergence of a parkinsonian disorder in 38% of 29 older men initially diagnosed with idiopathic rapid eye movement sleep behaviour disorder, Neurology, 1996;46:388–93.
  4. Olson EJ, Boeve BF, Silber MH, Rapid eye movement sleep behaviour disorder: demographic, clinical and laboratory findings in 93 cases, Brain, 2000;123:331–9.
  5. Ponsen MM, Stoffers D, Booij J, et al., Idiopathic hyposmia as a preclinical sign of Parkinson’s disease, Ann Neurol, 2004;56:173–81.
  6. Shiba M, Bower JH, Maraganore DM, et al., Anxiety disorders and depressive disorders preceding Parkinson’s disease: a case-control study, Mov Disord, 2000;15:669–77.
  7. Abbott RD, Petrovitch H, White LR, et al., Frequency of bowel movements and the future risk of Parkinson’s disease, Neurology, 2001;57:456–62.
  8. Boonstra TA, van der Kooij H, Munneke M, Bloem BR, Gait disorders and balance disturbances in Parkinson’s disease: clinical update and pathophysiology, Curr Opinion Neurol, 2008;21:461–71.
  9. Genever RW, Downes TW, Medcalf P, Fracture rates in Parkinson’s disease compared with age- and gendermatched controls: a retrospective cohort study, Age Ageing, 2005;34:21–4.
  10. Crosiers D, Meeus B, Nuytemans K, et al., Self-reported Non-motor Symptoms in a Cohort of 139 Parkinson’s Disease Patients, Presented at: 2nd World Parkinson Congress, Glasgow, UK, 28 September–1 October 2010.

Further Resources

Share this Article
Related Content In Parkinson's Disease
  • Copied to clipboard!
    accredited arrow-down-editablearrow-downarrow_leftarrow-right-bluearrow-right-dark-bluearrow-right-greenarrow-right-greyarrow-right-orangearrow-right-whitearrow-right-bluearrow-up-orangeavatarcalendarchevron-down consultant-pathologist-nurseconsultant-pathologistcrosscrossdownloademailexclaimationfeedbackfiltergraph-arrowinterviewslinkmdt_iconmenumore_dots nurse-consultantpadlock patient-advocate-pathologistpatient-consultantpatientperson pharmacist-nurseplay_buttonplay-colour-tmcplay-colourAsset 1podcastprinter scenerysearch share single-doctor social_facebooksocial_googleplussocial_instagramsocial_linkedin_altsocial_linkedin_altsocial_pinterestlogo-twitter-glyph-32social_youtubeshape-star (1)tick-bluetick-orangetick-red tick-whiteticktimetranscriptup-arrowwebinar Department Location NEW TMM Corporate Services Icons-07NEW TMM Corporate Services Icons-08NEW TMM Corporate Services Icons-09NEW TMM Corporate Services Icons-10NEW TMM Corporate Services Icons-11NEW TMM Corporate Services Icons-12Salary £ TMM-Corp-Site-Icons-01TMM-Corp-Site-Icons-02TMM-Corp-Site-Icons-03TMM-Corp-Site-Icons-04TMM-Corp-Site-Icons-05TMM-Corp-Site-Icons-06TMM-Corp-Site-Icons-07TMM-Corp-Site-Icons-08TMM-Corp-Site-Icons-09TMM-Corp-Site-Icons-10TMM-Corp-Site-Icons-11TMM-Corp-Site-Icons-12TMM-Corp-Site-Icons-13TMM-Corp-Site-Icons-14TMM-Corp-Site-Icons-15TMM-Corp-Site-Icons-16TMM-Corp-Site-Icons-17TMM-Corp-Site-Icons-18TMM-Corp-Site-Icons-19TMM-Corp-Site-Icons-20TMM-Corp-Site-Icons-21TMM-Corp-Site-Icons-22TMM-Corp-Site-Icons-23TMM-Corp-Site-Icons-24TMM-Corp-Site-Icons-25TMM-Corp-Site-Icons-26TMM-Corp-Site-Icons-27TMM-Corp-Site-Icons-28TMM-Corp-Site-Icons-29TMM-Corp-Site-Icons-30TMM-Corp-Site-Icons-31TMM-Corp-Site-Icons-32TMM-Corp-Site-Icons-33TMM-Corp-Site-Icons-34TMM-Corp-Site-Icons-35TMM-Corp-Site-Icons-36TMM-Corp-Site-Icons-37TMM-Corp-Site-Icons-38TMM-Corp-Site-Icons-39TMM-Corp-Site-Icons-40TMM-Corp-Site-Icons-41TMM-Corp-Site-Icons-42TMM-Corp-Site-Icons-43TMM-Corp-Site-Icons-44TMM-Corp-Site-Icons-45TMM-Corp-Site-Icons-46TMM-Corp-Site-Icons-47TMM-Corp-Site-Icons-48TMM-Corp-Site-Icons-49TMM-Corp-Site-Icons-50TMM-Corp-Site-Icons-51TMM-Corp-Site-Icons-52TMM-Corp-Site-Icons-53TMM-Corp-Site-Icons-54TMM-Corp-Site-Icons-55TMM-Corp-Site-Icons-56TMM-Corp-Site-Icons-57TMM-Corp-Site-Icons-58TMM-Corp-Site-Icons-59TMM-Corp-Site-Icons-60TMM-Corp-Site-Icons-61TMM-Corp-Site-Icons-62TMM-Corp-Site-Icons-63TMM-Corp-Site-Icons-64TMM-Corp-Site-Icons-65TMM-Corp-Site-Icons-66TMM-Corp-Site-Icons-67TMM-Corp-Site-Icons-68TMM-Corp-Site-Icons-69TMM-Corp-Site-Icons-70TMM-Corp-Site-Icons-71TMM-Corp-Site-Icons-72