Motor fluctuations in Parkinson’s disease: Perceptions and treatment

Abstract

Background: Levodopa is the gold standard of treatment for Parkinson’s disease, but wearing off leads to motor fluctuations in most patients. Therapeutic strategy for motor fluctuation management relies heavily on physician judgement; however, real-world insight into physician attitudes towards detection and treatment of motor fluctuations is lacking.
Methods: Multinational qualitative online surveys were conducted among general neurologists and movement disorder specialists treating patients with Parkinson’s disease in the UK, Germany, Italy, Spain, and Portugal in July 2020 (Wave 1) and September 2021 (Wave 2). The Perceptions and Attitudes questionnaire focused on attitudes towards detection and management of motor fluctuations by rating agreement with statements on a 7-point scale. The Treatment Landscape questionnaire involved completion of patient case reports (PCRs) for the four most recently treated patients with motor fluctuations. Results: Respondents agreed that motor fluctuations place a heavy burden on patients (82%/85% in Wave1/2, respectively) and are underdiagnosed (64%/72%), but most do not routinely use screening tools known to increase their detection. Just 3% of neurologists agreed completely with being confident in fully resolving motor fluctuations to their patient’s satisfaction. In contrast with the current evidence, most physicians perceive duration of levodopa treatment as a predictor of motor complications (72%/77%). Fractionating levodopa was the preferred first therapeutic strategy for motor fluctuation management versus adding an adjunct treatment. PCRs revealed that specialist neurologists used adjunct therapy more frequently than general neurologists, either as a first approach (31% versus 15%, respectively) or secondary to levodopa fractionating (62% versus 45%).
Conclusions: These surveys uncovered knowledge gaps around the predictors of motor fluctuations which could be addressed by future educational initiatives. Earlier detection of motor fluctuations and greater use of available adjunct treatments may help to reduce their burden in patients with Parkinson’s disease.