The role and structure of the multidisciplinary team in the management of advanced Parkinson’s disease with a focus on the use of levodopa–carbidopa intestinal gel

Abstract

Stephen W Pedersen,1 Martin Suedmeyer,2 Louis W C Liu,3 Dirk Domagk,4 Alison Forbes,5 Lars Bergmann,6 Koray Onuk,6 Ashley Yegin,6 Teus van Laar7 1Department of Neurology, Glostrup Hospital, University of Copenhagen, Glostrup, Copenhagen, Denmark; 2Department of Neurology, University of Düesseldorf, Düesseldorf, Germany; 3Division of Gastroenterology, Department of Medicine, University of Toronto, University Health Network, Toronto, ON, Canada; 4Department of Medicine I, Josephs-Hospital Warendorf, Academic Teaching Hospital, University of Muenster, Warendorf, Germany; 5PDNS consultant, AbbVie Inc., Roswell, GA, USA; 6Global Medical Affairs, AbbVie Inc., North Chicago, IL, USA; 7Department of Neurology, University Medical Center Groningen, Groningen, The Netherlands Abstract: A multidisciplinary team (MDT) approach is increasingly recommended in Parkinson’s disease (PD) treatment guidelines, but no standard of care exists for such an approach, and the guidelines do not provide clarification on how it should be implemented. This paper reviews evidence of MDT interventions in people with PD and provides expert clinical perspectives for an MDT approach, with a focus on advanced PD and levodopa–carbidopa intestinal gel (carbidopa–levodopa enteral suspension in the USA). The key recommendations are to enable the best possible treatment of people with PD locally by facilitating a close structured collaboration of different health care professionals working in a fixed network structure; to refer people with PD to established MDT centers in a timely manner; to establish regular meetings for the MDT enabling interdisciplinary exchange and learning; to optimize individual treatment and carefully evaluate available treatment options; to ensure treatment decisions are agreed jointly between people with PD, their caregivers, family, and health care professional; and to include specialists outside of neurology from adjuvant medical departments as necessary when implementing advanced therapies. Keywords: Parkinson’s disease, multidisciplinary team, advanced therapy, levodopa–carbidopa intestinal gel, carbidopa–levodopa enteral suspension

Keywords

• Parkinson’s disease
• multidisciplinary team
• advanced therapy
• levodopa-carbidopa intestinal gel
• carbidopa-levodopa enteral suspension