Review Article

Update on the Management of Parkinson’s Disease for General Neurologists

Table 4

Characteristics of patients with Parkinson’s disease who might be eligible for advanced device-aided therapies [29, 30, 58].

Characteristics of patients as proposed by expert-opinion studies
MotorNon-motorFunction

(i) Troublesome level of motor fluctuations [29, 30, 58]
(ii) At least 1 hour of the day with troublesome dyskinesia [30, 58]
(iii) At least 2 hours of the day with “off” time [29, 30, 58]
(iv) Off-period postural instability [29, 30]
(v) Dystonia with pain [30]
(vi) Freezing of gait during “off” time [30]
(vii) Daily multiple oral levodopa doses [58]
(i) Non-motor symptom fluctuations [58]
(ii) Impulse control disorder [58]
Troublesome level of nighttime sleep disturbances [30, 58]
(iii) Severe dysphagia and recurrent falls [29]
(iv) Troublesome level of daytime sleepiness [58]
(v) Troublesome level of anxiety [58]
(i) Needing help with activities of daily living at least some of the time (limited) [29, 30]

Proposed profiles according to clinical characteristics [30]
CharacteristicsApomorphineDeep brain stimulation (DBS)Levodopa carbidopa Intestinal gel (LCIG)

Younger age (<70 years)Probably good candidate [58]Probably good candidate [58]Probably good candidate [58]
Older age (>70 years)Probably good candidate [67, 68]Possible candidate [67, 68]Probably good candidate [67, 68]
Good levodopa responseProbably good candidate [58]Probably good candidate [58]Definitely good candidate [58]
Levodopa-resistant tremorNot a candidate [58, 67]Definitely good candidate [58, 67]Not a candidate [58, 67]
Troublesome dyskinesiaPossible candidateProbably good candidate [58]Probably good candidate [58]
Good cognitive functionProbably good candidate [58]Probably good candidate [58]Probably good candidate [58]
Nighttime sleep disturbancesPossible candidate [58]Possible candidate [58]Possible candidate [58]
PainPossible candidate [58]Possible candidate [58]Possible candidate [58]
Impulse control disorderNot a candidate [58, 67, 68]Possible candidate [58, 67, 68]Possible candidate [58, 67, 68]
DepressionPossible candidate [58, 68]Not a candidate [58, 68]Possible candidate [58, 68]
ApathyPossible candidate [58]Not a candidate [58]Possible candidate [58]
AnxietyNot a candidate [58]Possible candidate [58]Possible candidate [58]
Mild dementiaPossible candidate [67, 68]Not a candidate [67, 68]Possible candidate [67, 68]
MultimorbidityPossible candidate [67]/Not a candidate [68]Not a candidate [67]Possible candidate [67]/Not a candidate [68]
Lack of social support/caregiverNot a candidate [67]Possible candidate [67]Not a candidate [67]
Excessive daytime sleepinessNot a candidate [68]Possible candidate [68]Possible candidate [68]
DysphagiaProbably good candidate [68]Not a candidate [68]Probably good candidate [68]

In all studies cited, the recommendations are based on clinical experience and expert opinion in the absence of robust comparative evidence. If “possible” or “probably good” candidate is described, check warnings for use in the label that should be taken into consideration.