Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2023 Nov;130(11):1411-1432.
doi: 10.1007/s00702-023-02668-9. Epub 2023 Jul 12.

Access to device-aided therapies in advanced Parkinson's disease: navigating clinician biases, patient preference, and prognostic uncertainty

Manon Auffret  1   2   3 , Daniel Weiss  4 , Fabrizio Stocchi  5 , Marc Vérin  6   7   8 , Wolfgang H Jost  9
Affiliations
Review

Access to device-aided therapies in advanced Parkinson's disease: navigating clinician biases, patient preference, and prognostic uncertainty

Manon Auffret et al. J Neural Transm (Vienna). 2023 Nov.

Abstract

Device-aided therapies (DAT), which include deep brain stimulation and pump-based continuous dopaminergic stimulation with either levodopa or apomorphine, are among the major advances in the clinical management of Parkinson's disease (PD). Although DAT are being increasingly offered earlier in the disease course, their classical indication remains advanced PD. Theoretically, every patient should be offered transition to DAT when faced with refractory motor and nonmotor fluctuations and functional decline. Worldwide clinical reality is far from these ideal, and, therefore, question the "real-world" equal opportunity of access to DAT for PD patients with advanced PD-even within a single health care system. Differences in access to care, referral pattern (timing and frequency), as well as physician biases (unconscious/implicit or conscious/explicit bias), and patients' preferences or health-seeking behaviour are to be considered. Compared to DBS, little information is available concerning infusion therapies, as well as neurologists' and patients' attitudes towards them. This viewpoint aims to be thought-provoking and to assist clinicians in moving through the process of DAT selection, by including in their decision algorithm their own biases, patient perspective, ethical concerns as well as the current unknowns surrounding PD prognosis and DAT-related long-term side effects for a given patient.

Keywords: Clinician bias; Device-aided therapies; Parkinson’s disease; Patient preference; Personalised medicine.

PubMed Disclaimer

Conflict of interest statement

Manon Auffret reports travel grants, speakers and consultancy honoraria and/or research grants from France Parkinson, Plateforme Nationale pour la Recherche sur la Fin de Vie, Institut des Neurosciences Cliniques de Rennes, Aguettant, Britannia Pharmaceutical Ltd, Adelia Medical, Linde Homecare, Homeperf, Asdia, France Développement Electronique and Society for Dental Science. Dr. Auffret is employed by France Développement Electronique (FDE) and works as a hosted researcher at the Pontchaillou University Hospital and University of Rennes. Daniel Weiss: reports travel grants, speakers and consultancy honoraria and research grants from Abbvie, Abbott, Bial, Boston Scientific, Medtronic, Kyowa Kirin, Stadapharm. Fabrizio Stocchi: received compensation from Lundbeck, Biogen, Zambon, Bial, Britannia, Abbvie, Kiowa, Synegile, Sunovion, Neuroderm, Contera, Ever. Marc Vérin: served on scientific advisory boards, received research support and received travel grant from Aguettant, Britannia Pharmaceutical Ltd, Adelia Medical, Asdia Elivie, LVL, Orkyn. Wolfgang Jost is or was a consultant and/or speaker for the following companies: Abbvie, Bial, Brittania, Desitin, Stada, UCB, Zambon.

Figures

Fig. 1
Fig. 1
Factors to consider when prescribing device-aided therapies. DAT device-aided therapies, LCIG levodopa/carbidopa intestinal gel, PD Parkinson’s disease
Fig. 2
Fig. 2
Which device-aided therapy for which patient? A pragmatic approach. DBS deep brain stimulation, LCIG L-dopa carbidopa intestinal gel, LECIG L-dopa entacapone carbidopa intestinal gel, STN subthalamic nucleus, GPi globus pallidus internalis, VIM thalamic ventral intermedialis nucleus, high L-dopa sensitivity: < 1000 mg L-dopa/day; High L-dopa requirement: > 1000 mg L-dopa/day
See this image and copyright information in PMC

References

    1. Abate F, Erro R, Barone P, Picillo M. Managing device-aided treatments in Parkinson’s disease in times of COVID-19. Movement Disord Clin Pract. 2020;7(6):737–738. doi: 10.1002/mdc3.12985. - DOI - PMC - PubMed
    1. Abu Al-Melh M, Farghal M, Abdelall N (2022) Levodopa-carbidopa intestinal gel (LCIG) as an add-on therapy to deep brain stimulation (DBS) for managing progressive symptoms of advanced idiopathic Parkinson’s disease during the COVID-19 pandemic: case report [abstract]. Mov Disord 37 (suppl 1). https://www.mdsabstracts.org/abstract/levodopa-carbidopa-intestinal-gel-.... Accessed Feb 21, 2023
    1. Abu Snineh M, Camicioli R, Miyasaki JM. Decisional capacity for advanced care directives in Parkinson’s disease with cognitive concerns. Parkinsonism Relat Disord. 2017;39:77–79. doi: 10.1016/j.parkreldis.2017.03.006. - DOI - PubMed
    1. Ahlskog JE. Common Myths and Misconceptions That Sidetrack Parkinson Disease Treatment, to the Detriment of Patients. Mayo Clin Proc. 2020;95(10):2225–2234. doi: 10.1016/j.mayocp.2020.02.006. - DOI - PubMed
    1. Al-Busaidi IS, Alamri Y. Chper 8—Parkinson’s disease and social media. In: Martin CR, Preedy VR, editors. Diagnosis and Management in Parkinson’s Disease. Academic Press; 2020. pp. 125–138.

Publication types