Non-motor symptoms in advanced Parkinson’s

: The natural history and response to advanced therapies

Abstract

Background and Method
Non-motor symptoms (NMS) are a key determinant of health related quality of
life (HrQoL) in Parkinson’s disease (PD) (Martinez-Martin et al., 2011) and are
present in virtually every PD patient. Many aspects of NMS are treatable by
dopaminergic drugs (Chaudhuri and Schapira, 2009) and treating NMS remains
a key unmet need. (Chaudhuri et al., 2011) Currently treatment choices in
advanced PD are Apomorphine (Apo), intra-jejunal levodopa infusion (IJLI) and
Deep brain stimulation of the subthalamic nucleus (DBS-STN) and are solely
recommended based on motor symptoms.
This thesis addresses a range of comparative multicentre, international
collaborative studies of real life dopaminergic therapies in PD with a focus on
non-motor effects. Non-motor effect has been measured using the validated PD
non-motor symptoms scale (NMSS). (Chaudhuri et al., 2007) The largest real
life worldwide study with a long-term longitudinal follow-up design addresses a
key unmet need with over 40 patients in each arm. Using regression analysis
and comparative measures, effects on motor function, quality of life were
compared and contrasted with non-motor effects. A patient reported outcome
tool was developed using the same cohort of patients.
Results and Conclusion
This project has shown the beneficial effects of Apo, IJLI and DBS-STN
therapies on aspects of NMS in advanced Parkinson’s that translate to a robust
improvement in the HrQoL. For the first time we show that there are differences
between Apo, a dopamine agonist based therapy versus IJLI (a levodopa
therapy) on aspects of NMS and this would need to be explored further. The
effects could be explained by a central dopaminergic effect and effective
treatment of NMS arising from non-motor fluctuations. (Storch et al., 2013)
Choice of advanced therapies in PD should therefore take into account their
non-motor effects and patient expectations along with improvement of motor
symptoms.

Date of Award	2015
Original language	English
Awarding Institution	King's College London
Supervisor	Kallol Ray Chaudhuri (Supervisor) & Stephen Jackson (Supervisor)