Objective: Is PKG an effective way of monitoring advanced PD patients? Is it cost effective?
Can PKG be used to review and manage patients virtually?
Can PKG improve PD control and patient’s satisfaction?
Can PKG help to identify patients for advance therapies?

Background: Parkinson’s Disease is caused by neurological degeneration of dopaminergic neurons and affects all activities of daily living of a patient. In advance disease, comprehensive assessment through history and examination becomes difficult due to the fluctuating nature of the symptoms. PKG helps to monitor patient for 7 days to understand the fluctuation and response to the treatment.  By reviewing PKG, we can adjust the medications according to the response and complications. It helps to identify patients for advance therapies.

Method: We have been using PKG for the last four years and during pandemic it became the only tool to monitor these patients during lock down. We collected the data of last 50 PKGs to assess the effect of using PKG in the management of advance PD.

Results: 45 out of 50 patients were reviewed after the PKG. 82.22% had moderate to severe bradykinesia and tremors in spite of treatment. 55.55% had pre-dose wearing off, 35.55% had poor response to L-Dopa. 15.55% had delayed response, 22.22% had post dose dyskinesia and 26.67% had day time somnolence. 86.67% patients had combination of symptoms, 17.78% patients had pre-dose wearing off combined with post dost dyskinesia. As a result of PKG, 31.11% patients had their L-Dopa increased, 22.22% had their medication timing adjusted. 4.44% had COMT inhibitor added, another 4.44% had MAO B inhibitor added and 2.22% had Dopamine agonist increased. 4.44% had their Apo-morphine dose adjusted and 17.78% were referred for advance treatment (half for the Apo-morphine, rest for Duodopa and DBS). 22.22% had more than one adjustment. Patient’s satisfaction was high.

Conclusion: PKG gives clear picture of motor and non motor features to be used for the comprehensive assessment of the patients. It helps to adjust medication to improve the condition and can be used for remote monitoring of the patients. It can be used to assess patients for advance treatment or delay advance treatment (cost saving). It helps to identify patients who are non-responder to L-Dopa which helps to revisit the diagnosis/ management plan. It can be used to monitor patients remotely during lock down and can be used to reduce health professional appointments.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/pkg-for-the-management-of-advance-parkinsons-disease/