Impact of Infusion Therapies on Quality of Life in Advanced Parkinson’s Disease

Abstract

Viorelia A Constantin,1,* József A Szász,1,2,* Adriana Octaviana Dulamea,3,4 Peter Valkovic,5 Jaime Kulisevsky6 1Second Clinic of Neurology, Târgu Mures County Emergency Clinical Hospital, Târgu Mureș, Romania; 2Department of Neurology, George Emil Palade University of Medicine, Pharmacy, Science and Technology, Târgu Mureș, Romania; 3Neurology Clinic, Fundeni Clinical Institute, Bucharest, Romania; 4University of Medicine and Pharmacy “Carol Davila” Bucharest, Bucharest, Romania; 5Second Department of Neurology, Comenius University Faculty of Medicine and University Hospital Bratislava, Bratislava, Slovakia; 6Movement Disorders Unit at the Neurology Department of Sant Pau Hospital, Barcelona, Spain*These authors contributed equally to this workCorrespondence: Adriana Octaviana Dulamea, Tel [phone], Fax [phone], Email [email protected]: A high burden of motor and non-motor parkinsonian symptoms is known to have a significant negative impact on the quality of life (QoL) of people with Parkinson’s disease (PD). Effective control of these symptoms with therapies that enable patients to maintain a good QoL is therefore a key treatment goal in PD management. When symptom control can no longer be accomplished with oral or transdermal PD treatment regimens, device-aided therapies (DAT), namely levodopa and apomorphine infusion therapies, and deep brain stimulation, are valuable options to consider. DAT options may also help reduce pill burden and thereby improve compliance with treatment. Since PD therapy relies on symptomatic management, the efficacy and tolerability of any intervention is undoubtedly important, however the impact of different therapies on patient-related outcome measures, in particular health-related QoL, is also a critical consideration for those living with a chronic and disabling condition. This review discusses clinical evidence and ongoing research regarding the QoL benefits of levodopa and apomorphine infusion therapies from studies that have used validated QoL outcome measures. The data suggest that timing of these interventions is important to achieve optimal treatment effects, and that early initiation onto infusion therapies at the point when motor fluctuations emerge, and before patient QoL and functioning have significantly declined, may provide the best long-term outcomes. Healthcare professionals caring for people with PD should therefore discuss all available DAT options with them at an early stage in the course of their disease so they can make informed and timely choices that best suit them, their families and care network.Keywords: Parkinson’s disease, infusion therapies, motor symptoms, quality of life, patient-reported outcomes

Keywords

• parkinson’s disease
• infusion therapies
• motor symptoms
• quality of life
• patient-reported outcomes.