As Parkinson's progresses, more invasive therapies are used that require brain surgery, for example. When these no longer deliver the desired results, physicians often conclude that treatment options are exhausted. A study led by researchers at the Technical University of Munich (TUM) now shows that such patients can still benefit from a change in treatment. So far, however, this option has only been used very rarely.
Parkinson's disease is the world’s second-most common neurodegenerative disease after Alzheimer's. So far it has proved incurable. Only the symptoms can be treated. In early stages, tablets can generally provide relief from the complaints. As the disease progresses, this is often no longer enough.
In this case, invasive treatments are used. Apart from the high costs, these involve interventions of varying severity. The best-established of these treatments is deep brain stimulation, in which electrodes are implanted in the brain, similar to the use of pacemakers for heart patients. A more recent development is pump technology: the automated infusion of drugs directly into the intestines through a tube or into the abdominal wall with a needle. But even these advanced treatments do not always achieve the desired results or lose effectiveness over time. When that happens, physicians and patients are often reluctant to try a different invasive treatment or combine the current treatment with a second method. The conclusion is often reached that all options are exhausted. This can have a serious impact on quality of life and life expectancy.
Data from 22 Parkinson’s centers
A study by a team working with Prof. Paul Lingor, co-director of the Parkinson’s Outpatient Center at TUM Klinikum rechts der Isar, now offers new hope for these patients. The researchers collected data from 22 treatment centers all over Germany in the Competence Network Parkinson (Kompetenznetz Parkinson, KNP) covering the period from 2005 to 2021.
“Among the approximately 11,000 people undergoing advanced treatments at those centers during the study period, we were able to identify 116 persons in which advanced treatments were replaced or combined with an additional method,” says first author Dr. Dominik Pürner. Because some patients underwent more than one change in treatment, the researchers were able to analyze a total of 148 cases. The analysis of the data shows that most of these interventions were successful. For example, the physicians and patients reported a subjective improvement in mobility that was also reflected in objective tests.
National registry planned
“With people living longer, we will be faced more and more often with the question of what we can do for people when an advanced treatment fails,” says Paul Lingor. “We were able to show: The improvement for patients from a change in treatments is almost the same as when the original treatment is introduced. This is an enormous benefit.” Very few studies on changes in treatment have taken place to date in Germany or other countries. The researchers believe that their study has greatly improved the data situation, making it easier, for example, to determine which patient groups will benefit more from which strategy. This makes it possible to select a change in treatments on the basis of the dominant complaints.
“Based on the results of our study, we can now make a clear recommendation for action,” says Paul Lingor. “If an advanced treatment does not produce results or bring about the desired effects, a change in treatment should be considered. This insight is far from trivial, because it would have been entirely possible that all available treatments would fail at an advanced stage of the disease.” In the future the researchers wish to set up a Germany-wide registry including the data of all Parkinson’s patients undergoing device-based treatments in order to develop scientifically sound guidelines for the combination of advanced treatments.
D. Pürner, M. Hormozi, D. Weiß, M. T. Barbe, H. Jergas, T. Prell, E. Gülke, M. Pötter-Nerger, B. Falkenburger, L. Klingelhöfer, P. K. Gutsmiedl, B. Haslinger, A. M. Jochim, A. Wolff, N. Schröter, M. Rijntjes, C. van Riesen, U. Scheller, M. Wolz, A. Amouzandeh, G. Ebersbach, D. Gruber, Z. Kohl, W. Maetzler, S. Paschen, P. Pérez-González, V. Rozanski, J. Schwarz, M. Südmeyer, E. Torka, S. Wesbuer, S. Bornmann, A. Flöel, C. W. Ip, P. Krause, A. A. Kühn, I. Csoti, B. Herting, S. van de Loo, A. Ahammed Basheer, R. Liszka, W. H. Jost, J. Koschel, B. Haller, P. Lingor. „Nationwide Retrospective Analysis of Combinations of Advanced Therapies in Patients With Parkinson Disease“ Neurology (2023). DOI: 10.1212/WNL.0000000000207858
The authors wish to thank the participating centers from the Competence Network Parkinson (KNP) https://www.kompetenznetz-parkinson.de/
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Method of Research
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Nationwide Retrospective Analysis of Combinations of Advanced Therapies in Patients With Parkinson Disease
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Financial disclosures of all authors for the preceding 12 months MH, LK, PG, AW, NS, US, AA, DG, ZK, WM, PPG, JS, MS, ET, SW, CWI, BHert, SvdL, RL, BHal: No disclosures; DP: Congress fee from CSL Behring; MTB: Speaker honoraria from Medtronic, Boston Scientific, Abbot, GE Medical, UCB, Apotherkerverband Köln e.V., Bial, research funding from the Felgenhauer-Stiftung, Foschungspool Klinische Studien (University of Cologne), Horizon 2020 (Gondola), Medtronic (ODIS), Boston cientific, advisory honoraria for the IQWIG; HJ: Personal fees from Boston Scientific; TP: Grant from Bundesministerium für Bildung und Forschung (BMBF), honoraria from Abbvie, Licher; EG: Travel grants and honoraria for lectures from Abbvie, Abbott, Medtronic, Bial, Grifols, Kreiskrankenhaus Gummersbach, Zambon/Weser GmBH, co-editor of Thieme journal “Neurologieup2date”; MPN: Speaker honoraria and study reimbursement from Abbvie, Abbott, Medtronic, Boston Scientific, Licher, Zambon; BF: Grants from German Research Foundation (DFG), the German Society of Parkinson´s disease (dpv), speaker honoraria from Bial, Stadapharm, PD Neurotechnology, UCB, Zambon; AJ: Speaker honoraria and online congress fee from Abbvie; MR: Advisory boards Stadapharm, Abbvie, Zambon; CvR: Advisory board and consultancies Abbvie, Zambon; MW: Honoraria for presentations/advisory boards/consultations from Abbvie, Stadapharm, Zambon, Bial, Teva, Desitin, UCG; GE: Honoraria for advisory boards and consultancy from Abbvie, Bial, Desitin, Stada, Esteve Pharma, speaker honoraria from Abbvie, Bial, Britannia Pharma, Desitin, Esteve Pharma, Licher, Stadapharm, Zambon, royalties from Kohlhammer Verlag and Thieme Verlag; SP: Lecture fees from Medtronic, lecture fees and educational grants from Boston Scientific, lecture fees from Insightec; VR: Travel grants from Teva, Novartis; SB: Advisory boards Zambon, Bial; AF: Honoraria/expenses from Roche, Novartis, Biogen, Boehringer-Ingelheim, advisory boards/consulting Roche, Novartis, Biogen, Bayer; PK: Advisory board Medtronic, speaker honoraria Stadapharm, Abbvie; AK: Advisory board/honoraria Boston Scientific, Medtronic; IC: Speaker and advisory board honoraria from Bial, Roche, UCB, Kyowa Kirin; WJ: Speaker and advisory board honoraria from Abbvie, Desitin, Merz, Stadapharm, UCB, Zambon; JK: Travel grant Desitin, advisory board Abbvie; PL: Honoraria for advisory boards and consultancies from Stada, Abbvie, Alexion, Bial, ITF Pharma, Desitin, Woolsey Pharma.