Objective: To assess the feasibility of a wearable device for objective quantification of motor improvement in Parkinson’s Disease (PD) patients undergoing a therapy  from oral to continuous subcutaneous levodopa carbidopa infusion (Duodopa SP®)

Background: Evaluate the presence of motor fluctuation (MF) their response to different treatments  in PD can be challenging. Methods to assess therapy adjustments depend on short doctor’s visits and subjective tools. The introduction of validated medical devices could provide physicians with objective data for better medical insight

Method: 51 years old female with  PD of 8 years of evolution, 4 years with MF and not-MF, very disruptive the last year: severe off episodes with gait disorder and Freezing of Gait (FoG), ON b choreodystonia, biphasic dose onset dyskinesias. She  was referred for DBS, but bridging therapy was proposed. Patient was monitored using STAT-ON™ to  measure changes in motor symptoms across therapeutic interventions: transitioning from oral (V0) to apomorphine infusion (V1), to oral + inhaled levodopa (V2), and finally Duodopa SP® infusion (V3) (Table 1). STAT-ON™ was used to quantify improvements in MF. The bradykinesia index (BI), which correlates with UPDRS-III [1], is used to evaluate the state of a patient and considers a suboptimal state if scores are below 6.5 and an optimal state if scores exceed 8.5

Results: The patient  in V0:  43% dyskinesia and 20.9 FoG episodes per day. The BI reached values of 13.1 and 6.4 meaning high MF levels (Figure 1). In V1 (apomorphine) the dyskinesia decreased to 16.9%, but adverse events  provoked a reduction in the patient’s motor activity. When oral+inhaled levodopa was prescribed, the patient reduced the FoG episodes and biphasic dyskinesias, but decreased motor activity and ON time. Duodopa DP® started and at V3 improved time in OFF (-2.8%) and ON+INT (18%), MF were significantly controlled with BI between 7.6 and 11.2 and dyskinesia reduced up to 6.2% (Figure 2). The amount of activity and steps increased and FoG decreased drastically compared to the V0 reaching just 2 episodes per day. (Figure 3).

Conclusion: The motor state of PD patients can be objectively observed with STAT-ON. In this patient, Duodopa SP® therapy effect has been assessed. Duodopa DP® has shown to effectively control the symptoms, improving their time in OFF, ON, FoG, dyskinesia and Quality of Life.

Figure 2

Figure 1

Figure 3

Table 1

References: Rodríguez-Molinero A, et al. Analysis of correlation between an accelerometer-Based algorithm for Detecting Parkinsonian gait and UPDRS subscales. Front Neurol 2017;8:3–8. https://doi.org/10.3389/fneur.2017.00431.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/measuring-motor-improvement-with-a-wearable-device-in-a-parkinson-disease-patient-undergoing-subcutaneous-levodopa-carbidopa-infusion/