Objective: Could wearable sensors such as Parkinson’s kinetograph (PKG) may provide valuable overnight data to detect EMO to augment care in clinic.

Background: Early morning akinesia or off (EMO) periods have been shown to be common in diary based studies of levodopa treated Parkinson’s disease (PD) and associated with significant nonmotor symptoms as well as being intrusive to sleep quality. EMO is often clinically not detected or treated .

Method: In this ongoing retrospective and prospective analysis we are analysing data from 200 PKG datasets collected as part of the PKG registry at Kings College Hospital London and Poznan University Poland.  EMO was classified to pure EMO, EMO associated with daytime bradykinesia (BK)or no EMO (Figure) based on PKG bradykinesia percentiles ( normal <25) as well as visual grading independently corroborated by a blinded observer (DT) . Patient reported symptoms were then correlated.

Results: 80 records out of 250 have  been analysed (15 female) and EMO was seen in 41(51.2%, BK mean score 32.7 (normal <25)), EMO and significant daytime BK in 15 (18.7%, BK mean score 41.7) and no EMO in 24 (30%, BK mean score 22). Most EMO cases were unrecognised clinically and were on daytime treatment but no specific nighttime management strategies.

Conclusion: Wearable senor recording is available adjunct to clinical consultation for undetected significant EMO which is now treatable with 24 hour dopaminergic treatment strategies such as transdermal rotigotine, nighttime apomorphine infusion or subcutaneous foslevodopa/foscarbidopa infusion.

Fig : Representative EMO

Panel B: EMO+BK

References: Rizos et al . Parkinsonism Relat Disord . 2014 Nov;20(11):1231-5. doi: 10.1016/j.parkreldis.2014.09.013

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MDS Abstracts - https://www.mdsabstracts.org/abstract/characterising-early-morning-akinesia-and-off-emo-using-parkinsons-kinetigraph-analysis-from-a-two-centre-national-database-in-parkinsons-disease/