Objective: Our aim was to establish whether objective measurements using the Parkinson’s Kinetigraph can detect differences between patients undergoing different advanced therapy with either deep brain stimulation (DBS) or continuous infusion therapy (CIT).

Background: Continuous infusion therapy (with either levodopa-carbidopa intestinal gel or apomorphine) and DBS constitute our current armamentarium of advanced therapies in the management of Parkinson’s disease. Clinical algorithms for choice of advanced therapy are currently lacking and there are no currently widely accepted objective tools to aid decision-making. The PKG is a wrist-worn accelerometer that has been demonstrated to provide reliable quantitative measures of bradykinesia, dyskinesia and motor fluctuation. Using the PKG to objectively assess indications for advanced therapies and outcomes following initiation of these treatments may lead to better selection therapies for individual patients.

Methods: The PKG was worn by patients with Parkinson’s disease for a minimum of 6 days before and after the initiation of treatment with an advanced therapy. Eleven patients were treated with DBS and 10 patients were treated with CIT (5 with apomorphine and 5 with levodopa-carbidopa intestinal gel). Motor performance was assessed using the PKG measures of bradykinesia (BK), dyskinesia (DK) and motor fluctuation (FDS).

Results: Mean age at baseline was comparable for DBS and CIT patients but prior to treatment, DBS patients had lower BK scores and higher FDS scores compared to the CIT group. Within the DBS group, significantly higher BK scores and lower FDS scores were recorded post treatment. Within the CIT group there were no significant differences in BK, DK or FDS scores following treatment. Post treatment differences in scores between groups were not found although the sample size is small.

Conclusions: The findings suggest that infusion therapies are often selected in patients with a more advanced state of disease at the time of initiation. They also suggest that the PKG may be a useful tool to aid the selection of advanced therapy for patients with Parkinson’s disease. Furthermore, predicted patterns of change following initiation of an advanced therapy may be assessed quantitatively using the PKG which will help with titration of treatment, assessment of clinical outcome and provide a useful tool for further research.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/quantitative-assessment-of-advanced-therapies-in-parkinsons-disease-using-the-parkinson-kinetigraph-pkg/