Review Issues Updated Guidelines for General Neurologists on Management of Parkinson Disease

In a set of updated guidelines issued for general neurologists managing patients with Parkinson disease (PD), researchers note the significance of efficient communication with members of a healthcare team specialized in movement disorders (MD) as they may assist in identifying and resolving common issues, especially among those with advanced PD.

Published in Parkinson’s Disease, study authors highlight that the last 10 to 15 years has shown great progress within identifying, evaluating, and managing PD. While MD specialists are often aware of the emerging information available in scientific journals, researchers indicate that general neurologists, who are instrumental in diagnosis and routine management of PD, are often left out of the loop.

“Updates do not always reach general neurologists in a practical and useful way, potentially creating gaps in knowledge of PD between them and neurologists subspecialized in movement disorders, resulting in several unmet patient needs,” said the study authors.

Managing patients based on the stage of the disease is vital in slowing PD progression, with study authors indicating that appropriate use of available oral treatments may optimize conventional pharmacotherapy in patients. For example, patients with PD (PwP) at different stages who have received specific pharmacotherapies may need certain therapies later or may be at risk of certain symptoms based on their disease stage.

“As the disease progresses, successful management will increasingly require addition of more antiparkinsonian medications, as well as increased dosages and frequency of drug intake,” said the study authors.

The pharmacological history of each PwP plays a distinct role in deciding how to manage their disease, especially as researchers continue to learn more about the disease’s mechanisms. “While proper identification of these issues is crucial for further management, there is no definitive expert consensus on the actual medication picture of a candidate for switching to advanced PD therapies; that is, there is no agreement on the combination of drugs and dosages that would help define a patient no longer well controlled with regular oral medication.”

The role of nonpharmacological approaches were also referenced, such as exercise, which has been indicated in prior studies to improve motor symptoms and quality of life in PwP.

Ultimately, the importance of a multidisciplinary team was stressed by researchers to ensure that all needs of PwP were being addressed. Among those cited as integral participants, the neurologist/MD specialist and a specialized PD nurse would assist the general neurologist in managing PwP. “When and if needed—also with a psychologist, social worker, physiotherapist, occupational therapist, and speech therapist. These professionals are specially trained to provide advice, education, and support, which should be tailored to the needs of the individual patient and can be obtained much faster when in direct communication with experts,” said the study authors.

Researchers conclude by noting how the progressive and multifocal nature of PD adds to the complexity in managing the disease, which will require growing insight not only into mechanisms of the disorder but also into greater understanding of patients’ needs. “There is a lot that general neurologists can do for their patients with PD in earlier stages, as well as in advanced stages, particularly when in good and timely communication with a multidisciplinary team, whether for advice, support interventions, or referral when necessary.”

Reference

Pirtošek Z, Bajenaru O, Kovács N, et al. Update on the management of Parkinson's disease for general neurologists [published online March 26, 2020]. Parkinsons Dis. doi: 10.1155/2020/9131474.