By Dr Shalini Rao, Consultant Geriatrician, Princess of Wales Hospital

Parkinson’s Advanced MasterClass 34A, November 2018

 

Study questions:

  1. What are the indications for PKG use in our patient population with Parkinson’s disease?
  2. Does use of PKG lead to a change in Parkinson’s disease medication?
  3. Does use of PKG alter the use of complex non-oral therapy in Parkinson’s disease?

Methods:

45 PKG reports from patients with Idiopathic Parkinson’s disease (IPD) in the Movement Disorder Clinic in Bridgend, UK were studied. PKGs were performed between February 2016 and May 2018. 37 patients had a valid reason documented for performing PKG. 17 patients were male and 20 female. The average age was 71.6 years. The patients had a diagnosis of Parkinson’s disease ranging from 1 to 26 years. The average PD years was 6.37 years.

Results:

Wide ranges of indications for performing PKG were found. There were multiple indications for most patients. These included dose failure (14 patients), off periods and wearing off (11 patients), possibility of off dystonia or dyskinesia (5 patients), freezing, falls and postural hypotension relationship with medication (6 patients), bradykinesia and pain (7 patients) and to quantify dyskinesia (3 patients).

On clinical grounds, we felt that 10 of the 36 patients are likely to need a form of complex treatment before PKG.

After PKG, 4 patients started complex treatment (all had Apomorphine {Apo-Go} pen). One patient is being assessed for DBS. 5 patients did not need complex treatment but had a change to their medication resulting in increase in dosage of L-dopa in 4 patients and a decrease in dosage in one patient. We envisage that 2 of these 5 patients are likely to need a form of complex treatment in the near future.

We calculated the financial benefit of postponing complex treatment for 5 patients. Postponement of Apo-go pump (average cost of £5400/pump/year) led to a saving of £27,000 per year. Postponement of Apomorphine (Apo-go) pen treatment (average cost of £3,200/year) led to a saving of approx. £16,000 per year.

One patient was already on a complex treatment where Apo-go pen was changed to Apo go pump after PKG.

35 patients had a change to their PD medication after PKG. One patient had a diagnosis of PSP suspected because of absence of response to L-dopa on PKG. One patient had a PKG to quantify dyskinesia to assist with a DVLA report.

Furthermore, 13 patients were found to have mild to significant dyskinesia with 6 patients needing a reduction in drug doses. 26 patients were under treated, mostly with off-periods, with 23 patients needing an increase in drug dosage.

Tolerability:

All patients were able to complete the full recording of 6-7 days. No problems were reported from our patient cohort. We were unable to pick up excessive daytime somnolence or obsessive compulsive behaviour from the PKG data within our patient cohort.

Conclusion:

PKG is a useful diagnostic technique for patients with Complex Parkinson’s disease to delineate symptoms of dyskinesia, dystonia and wearing off periods. PKG often assists in a change in the patient’s medication leading to better symptom control. PKG can be useful in postponing complex treatments in IPD, resulting in significant financial saving.