Objective: The objective was to describe the spectrum of motor complications in a large cohort of patients with advanced Parkinson’s Disease (APD) who received at least four times a day levodopa combined treatment, reported at least 2 hours off periods/day (without early morning akinesia), with or without dyskinesia and during on phase were in at least Hoehn-Yahr stage 3. The patients were repeatedly evaluated to establish the opportunity of device aided therapy (DAT).

Background: Background: up to now there is no pragmatic, universally agreed on definition of APD nor a consensus regarding the maximal benefit that can be obtained with DAT. When motor complications, i.e. motor fluctuation and/or severe dyskinesia, cannot be controlled via peroral or transdermic treatments the patient should be guided to tertiary centers with expertise where multidisciplinary teams establish the suitability for DAT.

Method: Methods: We retrospectively reviewed all patients with APD evaluated in our department, Tirgu Mures University Teaching Hospital, between 1st June 2011 and 31st May 2017. We analyzed the particularities of motor complications based on anamnesis, referral or discharge letters, clinical evaluation and self-reported 24-hour diaries that are completed on 3 consecutive days prior to final evaluation.

Results: Results: out of the 311 patients with APD considered initially, 286 were fully evaluated (147 men, 139 women), with an average disease duration of 9.1±3.8 years (mean±SD). In this cohort the mean off period was 3.6±1.3 hours/day. Also, 110 patients had 2.7±0.9 hours/day dyskinesia and out of them 44 presented diphasic dyskinesia (3±0.8 hours/day) too. Early morning akinesia was present in 187 cases (mean duration 2.3±1.5 years). We considered that we reached the therapeutic limits of classical medication in 125 cases and for these patients DAT is suitable. These patients had 4.7±1 hours/day off periods, 82 had peak dose dyskinesia (3±0.8 hours/day) out of which 44 patients had also diphasic dyskinesia (3±0.8 hours/day). 117 patients had early morning akinesia with a mean duration of 2.7±1.7 years.

Conclusion: Conclusions: In evaluated patients that were considered suitable for DAT the severity of motor complications was in the upper end of the range found in other studies. We want to emphasize the relatively high rate of diphasic dyskinesias in our cohort.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/spectrum-of-motor-complications-in-advanced-parkinsons-disease-data-from-a-large-romanian-case-series-evaluated-for-suitability-for-device-aided-therapy/