Objective: To describe how Parkinson’s disease(PD) patients manage Ramadan fasting and the impact of the fasting period on symptoms 

Background: Although Ramadan fasting is not mandatory for patients suffering from chronic disease when fasting is at risk for health, many patients are tied to respect it. For most of PD patients several daily drug intakes are necessary to control the symptoms.To our knowledge, no previous studies have analyzed how PD patients manage Ramadan fasting

Methods: Twenty PD patients (60.4yo [range: 33-79], 9 females) seen in the outpatients department of Ibn Sina Hospital Kuwait, having planned to fast during the 2016 Ramadan were included. They underwent a clinical interview and a neurological examination, including the Movement disorder society-Unified Parkinson Disease Rating Scale (MDS-UPDRS), the Hoehn and Yahr staging scale, the non-motor symptom scale (NMSS), the quality of life scale (PDQ-39) and the clinical impression of severity index for Parkinson disease (CISI-PD). Assessments were performed 2 to 4 weeks before Ramadan and 2 to 4 weeks after It.

Results: Mean disease duration was 5.8y [1-20] with a Hoehn and Yahr score 1.8 [0 to 3]. Fourteen patients were treated with a combination of L-DOPA and dopamine agonist (DA), one patient with DA monotherapy and five patients were treated with L-DOPA monotherapy with a L-DOPA equivalent daily dosage (LEDD) of 820 mg(150-1584); 3 patients were treated with subthalamic DBS.To respect the fasting period, patients tried to change the timing of drug intake and have one intake before dawn and one after dusk with usually a higher dosage of drug per intake. Doing so, 6 were able to have no drug intakes between dusk and dawn.Eight patients maintained the same LEDD than before Ramadan fasting,10 decreased it [from 7 to 33%] and 2 increased it [from 7 to 11%].No serious side effects were reported, especially no hyperthermia linked to the rapid decrease of dopamine replacement treatment done in 10 patients was observed. -Compared to before Ramadan, there were no significant changes after the fasting period in PDQ 39 [40.6 (s.e.m. = 18.1) before[PD1]  vs. 40.2 (23.3) after], NMS [43.1 (24.0) vs. 43.1 (27.1)], CISI [6.1 (3.3) vs. 6.3 (3.2)]. No patients reported marked changes in weight.

Conclusions: With some adjustments in the treatment, patients with mild to moderate PD appear to manage Ramadan fasting well without serious damage to their health

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MDS Abstracts - https://www.mdsabstracts.org/abstract/how-do-parkinsons-disease-patients-manage-ramadan-fasting/