DISCREPA study: treatment of advanced Parkinson’s disease and use of second-line treatments in Catalonia
Introduction. The treatment of Parkinson’s disease (PD) is complex, and the establishment of second-line therapies in advanced PD remains controversial.
Aim. To analyze the assistance of patients with PD in Catalonia, with special attention to the use of second-line therapies in advanced PD.
Subjects and methods. Online self-administered survey to neurologists in Catalonia who treated patients with PD, through the Catalan Society of Neurology.
Results. 72 neurologists who visited a monthly average of 38 PD patients (37.3% motor complications) participated. 86% routinely asked about motor. The main reasons for indicating second-line therapies were disability in off (83.1%), impact of dyskinesias (76.9%), impact of time in off (75.4%) and time in off (73.8%). 70% of neurologists declared limitations to establish second-line therapies: lack of resources in their hospital, lack of time to visit the patient or to perform administrative tasks and lack nursing support. Second-line therapies is not used in 72% of patients who could potentially be candidates, especially due to patient rejection (37.9%).
Conclusions. The majority of neurologists in Catalonia who visit patients with PD routinely ask about motor complications without using specific tools. Although neurologists are well aware of the indications for the establishment of second-line therapies, the refusal of the patient, the lack of time and the lack of defined care protocols to refer patients, they can contribute to a lower use of second-line therapies in advanced PD.
Key words. Apomorphine infusion. Deep brain stimulation. Intraduodenal infusion of levodopa-carbidopa. Invasive treatment. Motor fluctuations. Parkinson’s disease.