Objective: Evaluate the efficacy and safety of therapeutic interventions to treat the motor symptoms in late stage PD.

Background: PD patients in late stage are very disabled from motor and nonmotor symptoms not responsive to levodopa. Late stage PD (LSPD) has been defined as PD patients in Hoehn & Yahr stage (HY) 4 or 5 or scoring < 50% in Schwab & England (SE) scale in on state. Patients at this late stage are usually not included in clinical trials, and thus therapeutic recommendations for these patients are based on extrapolation of results of clinical trials in other disease stages and in patients with similar clinical problems.

Methods:  A systematic review of randomized controlled trials (RCT) that included PD patients in HY stage 4 or 5 or SE score < 50% in on state, minimum duration of 4 weeks and enrolling ≥ 20 patients. Relevant trials were identified by electronic searches of the databases PubMed and Cochrane Library plus hand searching of major journals and reference lists of retrieved publications. Data were extracted independently by two reviewers. Search strategy used as term keywords “Parkinson’s disease”, “Dysarthria”, Dysphagia” or “deglutition disorders”, “dyskinesias”, “motor fluctuations”, “levodopa induced motor complications”, “falls”, “freezing”, “treatment” or “therapy”.

Results: A total of 288 trials were identified, of which 45 were RCT. Only 1 trial (treatment of dysphagia) specifically reports data of LSPD patients. 7 RCT, although including patients in LSPD, do not report their data separately.

Conclusions: LSPD patients are not being included in RCT for motor symptoms of PD. Treatment options for these very disabled patients are an unmet need.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/efficacy-and-safety-of-therapeutic-interventions-to-treat-motor-symptoms-in-late-stage-parkinsons-disease-a-systematic-review/