Continuous subcutaneous apomorphine infusion (CSAI) is, at present, an alternative option for advanced Parkinson's disease (PD) with motor fluctuations. We studied the evolution of patients with PD and severe motor fluctuations long-term treated with CSAI. We reviewed data from 82 patients with PD (mean age, 67 +/- 11.07; disease duration, 14.39 +/- 5.7 years) and severe motor fluctuations referred to 35 tertiary hospitals in Spain. These patients were long-term treated (for at least 3 months) with CSAI and tolerated the procedure without serious side effects. We compared the baseline data of these 82 patients (before CSAI) with those obtained from the last follow-up visit of each patient. The mean follow-up of CSAI was 19.93 +/- 16.3 months. Mean daily dose of CSAI was 72.00 +/- 21.38 mg run over 14.05 +/- 1.81 hours. We found a statistically significant reduction in off-hours, according to self-scoring diaries (6.64 +/- 3.09 vs. 1.36 +/- 1.42 hours/day, P < 0.0001), total and motor UPDRS scores (P < 0.0001), dyskinesia severity (P < 0.0006), and equivalent dose of antiparkinsonian therapy (1,405 +/- 536.7 vs. 800.1 +/- 472.9 mg of levodopa equivalent units P < 0.0001). CSAI is an effective option for patients with PD and severe fluctuations, poorly controlled by conventional oral drug treatment.

Background and objective: Parkinson’s disease (PD) is a clinically heterogeneous disorder in which the symptoms and prognosis can be very different among patients. We propose a new simple classification to identify key symptoms and staging in PD. Patients and Methods: Sixteen movement disorders specialists from Spain participated in this project. The classification was consensually approved after a discussion and review process from June to October 2021. The TNM classification and the National Institutes of Health Stroke Scale (NIHSS) were considered as models in the design. Results: The classification was named MNCD and included 4 major axes: (1) motor symptoms; (2) non-motor symptoms; (3) cognition; (4) dependency for activities of daily living (ADL). Motor axis included 4 sub-axes: (1) motor fluctuations; (2) dyskinesia; (3) axial symptoms; (4) tremor. Four other sub-axes were included in the non-motor axis: (1) neuropsychiatric symptoms; (2) autonomic dysfunction; (3) sleep disturbances and fatigue; (4) pain and sensory disorders. According to the MNCD, 5 stages were considered, from stage 1 (no disabling motor or non-motor symptoms with normal cognition and independency for ADL) to 5 (dementia and dependency for basic ADL). Conclusions: A new simple classification of PD is proposed. The MNCD classification includes 4 major axes and 5 stages to identify key symptoms and monitor the evolution of the disease in patients with PD. It is necessary to apply this proof of concept in a properly designed study.

Background: Recently, a novel simple classification called MNCD, based on 4 axes (Motor; Non-motor; Cognition; Dependency) and 5 stages, has been proposed to classify Parkinson's disease (PD). Objective: Our aim was to apply the MNCD classification in a cohort of PD patients for the first time and also to analyze the correlation with quality of life (QoL) and disease severity. Methods: Data from the baseline visit of PD patients recruited from 35 centers in Spain from the COPPADIS cohort fromJanuary 2016 to November 2017 were used to apply the MNCD classification. Three instruments were used to assess QoL:1) the 39-item Parkinson's disease Questionnaire [PDQ-39]); PQ-10; the EUROHIS-QOL 8-item index (EUROHIS-QOL8). Results: Four hundred and thirty-nine PD patients (62.05±7.84 years old; 59% males) were included. MNCD stage was:stage 1, 8.4% (N = 37); stage 2, 62% (N = 272); stage 3, 28.2% (N = 124); stage 4-5, 1.4% (N = 6). A more advancedMNCD stage was associated with a higher score on the PDQ39SI (p < 0.0001) and a lower score on the PQ-10 (p< 0.0001) and EUROHIS-QOL8 (p< 0.0001). In many other aspects of the disease, such as disease duration, levodopa equivalent daily dose, motor symptoms, non-motor symptoms, and autonomy for activities of daily living, an association between the stage and severity was observed, with data indicating a progressive worsening related to disease progression throughout the proposed stages. Conclusion: Staging PD according to the MNCD classification correlated with QoL and disease severity. The MNCD could be a proper tool to monitor the progression of PD.

INTRODUCCIÓNLa enfermedad de Parkinson (EP) es un trastorno neurodegenerativo crónico y progresivo de etiología desconocida. Afecta a un 2% de las personas mayores de 65 años y en un 10-15% de los casos comienza antes de los 40 años. Atendiendo a datos de diversos estudios epidemiológicos, puede estimarse que cerca de 100.000 personas sufren esta enfermedad en España y que cada año se realizan 8.000 nuevos diagnósticos (incidencia de 20 casos nuevos/100.000 habitantes/año). Al no conocerse la etiología, no existen tratamientos curativos ni preventivos [1]. Sin embargo, existen tratamientos farmacológicos que, al menos inicialmente, son altamente eficaces en el alivio de los síntomas de la enfermedad. Desafortunadamente, su eficacia disminuye con el tiempo de progresión de la enfermedad y, además, aparecen una serie de efectos adversos que son tan invalidantes como los propios síntomas de la EP (fenómenos on-off, discinesias, psicosis, etc.). En consecuencia, al cabo de varios años desde el diagnóstico, más del 70% de los pacientes ven notablemente alterada su calidad de vida al sufrir una intensa incapacidad que no puede mejorarse con los fármacos disponibles. A pesar de esta aparente homogeneidad clínica y evolutiva, la EP es un proceso de etiología, clínica y tratamiento muy heterogéneos [1].En el año 2000, un grupo de investigadores de EE. UU. dedicados al estudio de la EP elaboró una agenda de investigación. Entre otras cosas, en esa agenda se resaltaba la importancia de disponer de registros de pacientes: 'Para la realización de la gran mayoría de estudios genéticos y epidemiológicos, la constitución de un registro de pacientes y su disponibilidad en la red (página web) debe ser una prioridad urgente. Para ello hace falta un esfuerzo cooperativo de diferentes grupos. [...] Es importante señalar que la genética influye no sólo en el riesgo de desarrollar EP, sino también en la respuesta al tratamiento. Esta razón es de suficiente importancia como para considerar oportuno recoger y almacenar muestras biológicas de tal modo que puedan realizarse análisis retrospectivos de grupos de pacientes adecuadamente estudiados desde el punto de vista clínico, para determinar si han existido grupos que han evolucionado y han respondido a fármacos de una determinada manera según su background genético'.En los últimos años se están destinando ingentes cantidades de recursos personales y económicos a la creación de potentes plataformas tecnológicas para que, en un futuro, puedan realizarse estudios a gran escala de genes, polimorfismos (SNP) o proteínas. Paradójicamente, se está invirtiendo muy poco en el CREATION AND STANDARDIZED LONGITUDINAL FOLLOW-UP OFA COHORT OF PATIENTS WITH DE NOVO PARKINSON'S DISEASE: THE VIP PROJECT Summary. Introduction. Parkinson's disease (PD) is a quite heterogeneous disorder, thus difficulting the interpretation of transversal studies. Patients' registries and longitudinal studies can be considered as a priority in order to understand many still unknown aspects of the disease. Aim. To create and...

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