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Journal of Neurology
Published in: Journal of Neurology 3/2021

01-03-2021 | Parkinson's Disease | Original Communication

Assessment of Wearing Off in Parkinson’s disease using objective measurement

Authors: Parisa Farzanehfar, Holly Woodrow, Malcolm Horne

Published in: Journal of Neurology | Issue 3/2021

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Abstract

Background

Development of “Wearing Off” (WO) of motor and non-motor function in Parkinson’s disease (PD) adversely affects quality of life. This suggest that identifying and treating WO is important. However, identification of WO depends on people with PD (PwP) recognising and reporting WO and there is a perception that WO may be significantly underestimated.

Objective

We investigate the feasibility of identifying “Wearing Off” using objective measurement and assess the clinical benefit in rectifying it.

Method

In this study, 200 PwP were studied for evidence of WO using a continuously worn wearable system. Eighty-five patients (43%) were found to have WO and treatment was changed to mitigate the effects of WO.

Results

Factors, such as duration of disease, high baseline MDS-UPDRS (motor component), high Percent Time in Bradykinesia (PTB), high Levodopa Equivalent Daily Dose (LEDD), frequent Levodopa doses and younger age of onset, are associated with severity of motor complications. Patients with more severe WO experienced worse motor and non-motor symptoms and lower quality of life. Quality of life significantly improved in PwP when WO was treated.

Conclusion

The findings reported in this study provide evidence that identifying and treating WO improves outcomes of PwP and that objective measurements may help clinicians to identify and treat WO.
Literature
1.
Kim YE, Jeon B, Yun JY, Yang H-J, Kim H-J (2019) Chronological view of peak and diphasic dyskinesia, Wearing Off and Freezing of Gait in Parkinson’s Disease. J Parkinson’s Dis 1:1–7
2.
Stacy M, Bowron A, Guttman M, Hauser R, Hughes K, Larsen JP et al (2005) Identification of motor and nonmotor wearing-off in Parkinson’s disease: comparison of a patient questionnaire versus a clinician assessment. Movement Disord Off Journal Soc 20(6):726–733
3.
Marsden CD, Parkes JD (1976) "On-off" effects in patients with Parkinson's disease on chronic levodopa therapy. Lancet 1(7954):292–296PubMed
4.
Wan Y, Yuan C, Hou X, Chen W, Wang C, Gao S et al (2020) Wearing-off Identification in Parkinson’s Disease: the shapd-woq Study. Front Neurol 11:116PubMedPubMedCentral
5.
Ahlskog JE, Muenter MD (2001) Frequency of levodopa-related dyskinesias and motor fluctuations as estimated from the cumulative literature. Movement Disord Off J Soc 16(3):448–458
6.
Group PS (2000) Pramipexole vs levodopa as initial treatment for Parkinson disease: a randomized controlled trial. JAMA 284(15):1931–1938
7.
Aarsland D, Andersen K, Larsen JP, Lolk A, Kragh-Sorensen P (2003) Prevalence and characteristics of dementia in Parkinson disease: an 8-year prospective study. Arch Neurol 60(3):387–392PubMed
8.
Ashe J, Vitek J, Delong M, Alexander G (1990) Evidence for somatotopic organization within thalamic nucleus VLo (ventralis lateralis pars oralis). Soc Neurosci Abstr 16:425
9.
Nutt JG (2008) Pharmacokinetics and pharmacodynamics of levodopa. Movement Disord Off J Soc 23(S3):S580–S584
10.
Lee J, Zhu W-M, Stanic D, Finkelstein DI, Horne MH, Henderson J et al (2008) Sprouting of dopamine terminals and altered dopamine release and uptake in Parkinsonian dyskinaesia. Brain 131(6):1574–1587PubMed
11.
Kurowska Z, Kordower JH, Stoessl AJ, Burke RE, Brundin P, Yue Z et al (2016) Is axonal degeneration a key early event in Parkinson’s disease? J Parkinson's Dis 6(4):703–707
12.
Rodríguez-Violante M, Ospina-García N, Dávila-Avila NM, Cruz-Fino D, Adl C-L, Cervantes-Arriaga A (2018) Motor and non-motor wearing-off and its impact in the quality of life of patients with Parkinson's disease. Arq Neuropsiquiatr 76(8):517–521PubMed
13.
Dodel RC, Berger K, Oertel WH (2001) Health-related quality of life and healthcare utilisation in patients with Parkinson’s disease. Pharmacoeconomics 19(10):1013–1038PubMed
14.
Schrag A, Quinn N (2000) Dyskinesias and motor fluctuations in Parkinson’s disease: a community-based study. Brain 123(11):2297–2305PubMed
15.
Stacy M (2010) The wearing-off phenomenon and the use of questionnaires to facilitate its recognition in Parkinson’s disease. J Neural Trans 117(7):837–846
16.
Antonini A, Martinez-Martin P, Chaudhuri RK, Merello M, Hauser R, Katzenschlager R et al (2011) Wearing-off scales in Parkinson’s disease: critique and recommendations. Mov Disord 26(12):2169–2175PubMed
17.
Hauser RA, Deckers F, Lehert P (2004) Parkinson's disease home diary: further validation and implications for clinical trials. Mov Disord 19(12):1409–1413PubMed
18.
Martinez-Martin P, Hernandez B (2012) The Q10 questionnaire for detection of wearing-off phenomena in Parkinson’s disease. Parkinsonism Relat Disord 18(4):382–385PubMed
19.
Raciti L, Nicoletti A, Mostile G, Bonomo R, Contrafatto D, Dibilio V et al (2016) Validation of the UPDRS section IV for detection of motor fluctuations in Parkinson's disease. Parkinsonism Relat Disord 27:98–101PubMed
20.
Stacy M (2010) The wearing-off phenomenon and the use of questionnaires to facilitate its recognition in Parkinson's disease. J Neural Transm (Vienna) 117(7):837–846
21.
Matthews H, Stamford J, Saha R, Martin A (2015) Off-Park survey steering g. Exploring issues around wearing-off and quality of life: the OFF-PARK survey of people with Parkinson’s disease and their care partners. J Parkinsons Dis 5(3):533–539PubMed
22.
Storch A, Schneider CB, Wolz M, Sturwald Y, Nebe A, Odin P et al (2013) Nonmotor fluctuations in Parkinson disease: severity and correlation with motor complications. Neurology 80(9):800–809PubMed
23.
Chou KL, Stacy M, Simuni T, Miyasaki J, Oertel WH, Sethi K et al (2018) The spectrum of “off” in Parkinson’s disease: What have we learned over 40 years? Parkinsonism Relat Disord 51:9–16PubMed
24.
Horne M, Kotschet K, Braybrook M (2016) Objective measurement in clinical care of patients with Parkinson’s disease. Movement Disord 31:2
25.
Maier F, Prigatano GP (2017) Impaired self-awareness of motor disturbances in Parkinson’s disease. Arch Clin Neuropsychol 32(7):802–809PubMed
26.
Farzanehfar P, Braybrook M, Kotschet K, Horne M (2016) Objective measurement in clinical care of patients with Parkinson’s disease: an RCT using the PKG. Internat Congress Parkinons’ Disorders and Movement, Berlin, Germany
27.
Maetzler W, Klucken J, Horne M (2016) A clinical view on the development of technology-based tools in managing Parkinson’s disease. Movement Disord Off J Soc 31(9):1263–1271
28.
Farzanehfar P, Braybrook M, Kotschet K, Horne M (2016) Objective Measurement in Clinical Care of Patients with Parkinson’s disease: an RCT using the PKG. International Congress of Parkinons’ Disorders and Movement Disorders Berlin, Germany
29.
Farzanehfar P, Woodrow H, Braybrook M, McGregor S, Evans A, Nicklason F et al (2018) Objective measurement in routine care of people with Parkinson's disease improves outcomes. NPJ Parkinsons Dis 4:10PubMedPubMedCentral
30.
Khodakarami H, Ricciardi L, Contarino MF, Pahwa R, Lyons KE, Geraedts VJ et al (2019) Prediction of the levodopa challenge test in Parkinson's Disease using data from a Wrist-Worn Sensor. Sensors (Basel) 19:23
31.
Odin P, Chaudhuri KR, Volkmann J, Antonini A, Storch A, Dietrichs E et al (2018) Viewpoint and practical recommendations from a movement disorder specialist panel on objective measurement in the clinical management of Parkinson's disease. NPJ Parkinsons Dis 4:14PubMedPubMedCentral
32.
Farzanehfar P, Woodrow H, Braybrook M, McGregor S, Evans A, Nicklason F et al (2018) Objective measurement in routine care of people with Parkinson’s disease improves outcomes. npj Parkinson’s Disease. 4(1):1–8PubMedPubMedCentral
33.
Odin P, Chaudhuri KR, Volkmann J, Antonini A, Storch A, Dietrichs E et al (2018) Viewpoint and practical recommendations from a movement disorder specialist panel on objective measurement in the clinical management of Parkinson’s disease. NPJ Parkinson’s Dis 4(1):1–7
34.
McGregor S, Churchward P, Soja K, O’Driscoll D, Braybrook M, Khodakarami H et al (2018) The use of accelerometry as a tool to measure disturbed nocturnal sleep in Parkinson’s disease. Npj Parkinson’s Dis 4(1):1–7
35.
Braybrook M, O’Connor S, Churchward P, Perera T, Farzanehfar P, Horne M (2016) An ambulatory tremor score for Parkinson’s disease. J Parkinson’s Dis 6(4):723–731
36.
Griffiths RI, Kotschet K, Arfon S, Xu ZM, Johnson W, Drago J et al (2012) Automated assessment of bradykinesia and dyskinesia in Parkinson’s disease. J Parkinson’s Dis 2(1):47–55
37.
Horne M, Kotschet K, McGregor S (2016) The clinical validation of objective measurement of movement in Parkinson’s disease. CNS 2:7
38.
Farzanehfar P, Horne M (2017) Evaluation of the Parkinson’s KinetiGraph in monitoring and managing Parkinson’s disease. Expert Rev Med Dev 14(8):583–591
39.
Khodakarami H, Farzanehfar P, Horne M (2019) The use of data from the Parkinson’s KinetiGraph to identify potential candidates for device assisted therapies. Sensors 19(10):2241
40.
Kotschet K, Johnson W, McGregor S, Kettlewell J, Kyoong A, O'Driscoll DM et al (2014) Daytime sleep in Parkinson's disease measured by episodes of immobility. Parkinsonism Relat Disord 20(6):578–583PubMed
41.
Braybrook M, O'Connor S, Churchward P, Perera T, Farzanehfar P, Horne M (2016) An ambulatory tremor score for Parkinson’s disease. J Parkinsons Dis 6(4):723–731PubMed
42.
Khodakarami H, Ricciardi L, Contarino MF, Pahwa R, Lyons KE, Geraedts VJ et al (2019) Prediction of the Levodopa challenge test in Parkinson’s disease using data from a wrist-worn sensor. Sensors 19(23):5153
43.
Odin P, Chaudhuri KR, Slevin J, Volkmann J, Dietrichs E, Martinez-Martin P et al (2015) Collective physician perspectives on non-oral medication approaches for the management of clinically relevant unresolved issues in Parkinson’s disease: consensus from an international survey and discussion program. Parkinsonism Related Disord 21(10):1133–1144
44.
Melo LM, Chien HF, Barbosa ER (2010) Identification of wearing-off manifestations (reduction of levodopa effect) in Parkinson’s disease using specific questionnaire and comparison of the results with routine ambulatory evaluations. Arq Neuropsiquiatr 68(4):506–510PubMed
45.
Odin P, Ray Chaudhuri K, Slevin JT, Volkmann J, Dietrichs E, Martinez-Martin P et al (2015) Collective physician perspectives on non-oral medication approaches for the management of clinically relevant unresolved issues in Parkinson’s disease: Consensus from an international survey and discussion program. Parkinsonism Relat Disord 21(10):1133–1144PubMed
46.
Warren Olanow C, Kieburtz K, Rascol O, Poewe W, Schapira AH, Emre M et al (2013) Factors predictive of the development of Levodopa-induced dyskinesia and wearing-off in Parkinson's disease. Mov Disord 28(8):1064–1071PubMed
Metadata
Title
Assessment of Wearing Off in Parkinson’s disease using objective measurement
Authors
Parisa Farzanehfar
Holly Woodrow
Malcolm Horne
Publication date
01-03-2021
Publisher
Springer Berlin Heidelberg
Published in
Journal of Neurology / Issue 3/2021
Print ISSN: 0340-5354
Electronic ISSN: 1432-1459
DOI
https://doi.org/10.1007/s00415-020-10222-w

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