Objective: The aim of our study is to assess whether our patients with Parkinson’s disease (PD) met recommended criteria to perform advanced therapy (AT) like subthalamic nuclei deep brain stimulation (DBS) and continuous levodopa-carbidopa intestinal gel (LCIG).

Background: In advanced Parkinson’s disease with motor fluctuations and dyskinesia, AT have demonstrated their efficacy over the last 20 years [1]. Although it is now established that they should be introduced as soon as motor fluctuations appear [1], a lot of patients did not access to AT. Indeed, patients are referred too late [2].

Some authors have proposed criteria to identify eligible patients, such as the 5-2-1 criteria [3] or the criteria proposed by the Moes team [2].

Method: This study includes retrospectively all PD patients who underwent an AT in the last 10 years in our center.

Clinical features were observed at AT performance time. Motor and non-motor symptoms were evaluated by MDS-UPRDS part I to IV and NMSS scale. Motor complications were specifically observed by the UPDRS IV items. Levodopa equivalent dose daily (LEDD) and levodopa intake (LDI) were recorded.

We compared two groups, STN-DBS and LCIG patients, to assess which clinical features were predominant in each AT group.

Results: 30 STN-DBS patients and 15 LCIG patients were included.

Compared to LCIG patients, DBS patients had a younger age (p<0,001), a shorter disease duration (p=0,038), fewer non-motor symptoms (UPDRS I – p=0,038), less impact on their daily activities (UPDRS 2 p=0,029), fewer motor symptoms (UPDRS III ON p=0,019 & OFF p=0,006) and fewer LDI (p=0,035).

DBS patients were significatively different by LCIG patients in term of painful dyskinesia (item 34 of UPDRS IV – p=0,021), predictable & unpredictable OFF (item 36&37 – p<0,001 – p=0,016), sudden OFF (item 3 – p=0,01), and sex (p=0,019).

93,3% of DBS patients and 100% of LCIG patient meet 5-2-1 criteria.

56,7% of DBS patients and 42,9% of LCIG patient meet Moes criteria.

Conclusion: DBS patients have milder PD form but have more painful dyskinesia and more predictable OFF.

LCIG patients have more unpredictable OFF, more sudden OFF and longer OFF time.

Women benefit less from DBS than men.

5-2-1 criteria seems to be a good indicator to perfom AT. However, almost 50% of our patients would not have benefited from AT using the Moes criteria.

References: 1. Dijk JM, Espay AJ, Katzenschlager R, de Bie RMA. The Choice Between Advanced Therapies for Parkinson’s Disease Patients: Why, What, and When? J Parkinsons Dis. 2020;10(s1):S65-S73.
2. Moes HR, Ten Kate JM, Portman AT, van Harten B, van Kesteren ME, Mondria T, Lunter G, Buskens E, van Laar T. Timely referral for device-aided therapy in Parkinson’s disease. Development of a screening tool. Parkinsonism Relat Disord. 2023 Apr;109:105359.
3. Santos-García D, de Deus Fonticoba T, Suárez Castro E, Aneiros Díaz A, McAfee D. 5-2-1 Criteria: A Simple Screening Tool for Identifying Advanced PD Patients Who Need an Optimization of Parkinson’s Treatment. Parkinsons Dis. 2020 Mar 24;2020:7537924.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/indications-of-advanced-therapies-in-parkinsons-disease-a-retrospective-study-in-a-belgian-reference-center/