Nationwide Retrospective Analysis of Combinations of Advanced Therapies in Patients With Parkinson Disease

Pürner, Dominik; Hormozi, Mohammad; Weiß, Daniel; Barbe, Michael T.; Jergas, Hannah; Prell, Tino; Gülke, Eileen; Pötter-Nerger, Monika; Falkenburger, Björn; Klingelhöfer, Lisa; Gutsmiedl, Pia K.; Haslinger, Bernhard; Jochim, Angela M.; Wolff, Andreas; Schröter, Nils; Rijntjes, Michel; van Riesen, Christoph; Scheller, Ute; Wolz, Martin; Amouzandeh, Ali; Ebersbach, Georg; Gruber, Doreen; Kohl, Zacharias; Maetzler, Walter; Paschen, Steffen; Pérez-González, Pablo; Rozanski, Verena; Schwarz, Johannes; Südmeyer, Martin; Torka, Elisabeth; Wesbuer, Simone; Bornmann, Sarah; Flöel, Agnes; Ip, Chi Wang; Krause, Patricia; Kühn, Andrea A.; Csoti, Ilona; Herting, Birgit; van de Loo, Simone; Basheer, Aniz Ahammed; Liszka, Robert; Jost, Wolfgang H.; Koschel, Jiri; Haller, Bernhard; Lingor, Paul

doi:10.1212/wnl.0000000000207858

Cited by 3 publications

(2 citation statements)

References 44 publications

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“…This is also supported by several recent studies, which have shown that patients also benefit from a combination or sequential application of various intensified therapies. Several retrospective case series show that both the combination and the sequential use of intensified therapeutic procedures can lead to significant clinical improvement (Sesar et al 2019;Georgiev et al 2022;Pürner et al 2023). This is supported by a small prospective case series that showed a significant decrease in motor impairment with the addition of LCIG in patients with DBS and therapy-refractory symptoms (Regidor et al 2017).…”

Section: Deep Brain Stimulation (Dbs)mentioning

confidence: 89%

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Advanced therapies in Parkinson’s disease: an individualized approach to their indication

Schröter,

Sajonz,

Jost

et al. 2024

J Neural Transm

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Device aided therapies (DAT) comprising the intrajejunal administration of levodopa/carbidopa intestinal gel (LCIG) and levodopa/carbidopa/entacapone intestinal gel (LECIG), the continuous subcutaneous application of foslevodopa/foscarbidopa or apomorphine infusion (CSAI) and deep brain stimulation (DBS) are used to treat Parkinson’s disease with insufficient symptom alleviation under intensified pharmacotherapy. These DAT significantly differ in their efficacy profiles, indication, invasiveness, contraindications, and potential side effects. Usually, the evaluation of all these procedures is conducted simultaneously at the same point in time. However, as disease progression and symptom burden is extremely heterogeneous, clinical experience shows that patients reach the individual milestones for a certain therapy at different points in their disease course. Therefore, advocating for an individualized therapy evaluation for each DAT, requiring an ongoing evaluation. This necessitates that, during each consultation, the current symptomatology should be analyzed, and the potential suitability for a DAT be assessed. This work represents a critical interdisciplinary appraisal of these therapies in terms of their individual profiles and compares these DAT regarding contraindications, periprocedural considerations as well as their efficacy regarding motor- and non-motor deficits, supporting a personalized approach.

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Section: Deep Brain Stimulation (Dbs)mentioning

confidence: 89%

“…Depending on the clinical scenario, a patient may undergo multiple procedures consecutively, such as apomorphine as a bridging therapy for later DBS or pump therapy. It is also possible to combine therapies (Pürner et al 2023). To assist in the decisionmaking process, an international guideline was published in 2022 (Deuschl et al 2022).…”

Section: Introductionmentioning

confidence: 99%

Advanced therapies in Parkinson’s disease: an individualized approach to their indication

Schröter,

Sajonz,

Jost

et al. 2024

J Neural Transm

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Winding Back the Clock on Advanced Therapies: It’s Time to Get Smart

Georgiades,

van der Plas,

Bloem

et al. 2024

Journal of Parkinson’s Disease

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Our language affects patients’ perceptions of therapies. In Parkinson’s disease, emergent response fluctuations and dyskinesias typically trigger conversations around commencing an “Advanced Therapy” which carries notions of Advanced Disease. The patient, resolute in their commitment to fighting the disease, is misled. Chasing reassurance that their disease has not yet progressed considerably; they may therefore resist a potentially life-changing therapy. Instead, we should offer a “Smart Therapy”. This term more accurately and positively describes therapies on offer that stabilize response fluctuations and improve quality of life, without a focus on the negative connotations of progression to more advanced disease.

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HYBRIDMINDS—summary and outlook of the 2023 international conference on the ethics and regulation of intelligent neuroprostheses

Buthut,

Starke,

Akmazoglu

et al. 2024

Front. Hum. Neurosci.

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Neurotechnology and Artificial Intelligence (AI) have developed rapidly in recent years with an increasing number of applications and AI-enabled devices that are about to enter the market. While promising to substantially improve quality of life across various severe medical conditions, there are also concerns that the convergence of these technologies, e.g., in the form of intelligent neuroprostheses, may have undesirable consequences and compromise cognitive liberty, mental integrity, or mental privacy. Therefore, various international organizations, such as the Organization for Economic Cooperation and Development (OECD) or United Nations Educational, Scientific and Cultural Organization (UNESCO), have formed initiatives to tackle such questions and develop recommendations that mitigate risks while fostering innovation. In this context, a first international conference on the ethics and regulation of intelligent neuroprostheses was held in Berlin, Germany, in autumn 2023. The conference gathered leading experts in neuroscience, engineering, ethics, law, philosophy as well as representatives of industry, policy making and the media. Here, we summarize the highlights of the conference, underline the areas in which a broad consensus was found among participants, and provide an outlook on future challenges in development, deployment, and regulation of intelligent neuroprostheses.

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Nationwide Retrospective Analysis of Combinations of Advanced Therapies in Patients With Parkinson Disease

Cited by 3 publications

References 44 publications

Advanced therapies in Parkinson’s disease: an individualized approach to their indication

Advanced therapies in Parkinson’s disease: an individualized approach to their indication

Winding Back the Clock on Advanced Therapies: It’s Time to Get Smart

HYBRIDMINDS—summary and outlook of the 2023 international conference on the ethics and regulation of intelligent neuroprostheses

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