title: Advanced stages of PD: interventional therapies and related patient-centered care.
abstract: During the last decades, symptomatic treatment of motor symptoms of Parkinson's disease (PD) improved continuously and is reflected by long-range independency of the patient during the disease course. However, advanced stages of PD still represent an important challenge to patients, caregivers and treating physicians. In patients with advanced PD, interventional therapy strategies are increasingly applied. These device-related treatment strategies using pump-based continuous dopaminergic stimulation (CDS) or deep brain stimulation (DBS) opened new treatment options especially if motor complications predominate. Well-designed clinical studies on these interventional therapeutic approaches provided class 1 evidence for the efficacy of DBS and CDS in advanced PD and opened new perspectives for their use in earlier disease stages also. Therefore, careful selection of patients amenable to the (semi)invasive therapy options becomes more and more important and requires an interdisciplinary setting that accounts for (i) optimal patient information and awareness, (ii) selection of best individual treatment modality, (iii) training of relatives and caregivers, (iv) management of complications, and (v) follow-up care. Here, we address these topics by summarizing current state-of-the-art in patient selection, providing specificities of treatment options and troubleshooting, and defining steps towards an optimized patient-centered care. Interventional therapies pioneer in the area of individualized treatment approaches for PD, and may be complemented in the future by biomarker-based improved stratification and by closed-loop systems for adaptive therapeutic strategies. In the present review, we summarize the proceedings of an Expert Workshop on Parkinson's disease held on November 22, 2014 in Frankfurt, Germany.
authors.affiliation: Clinical and Experimental Neuroscience, Luxembourg Centre for Systems Biomedicine, University of Luxembourg, Esch-sur-Alzette, Luxembourg. rejko.krueger@uni.lu.|Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg. rejko.krueger@uni.lu.
authors.forename: Rejko
authors.initials: R
authors.lastname: Krüger
authors.affiliation: Department of Neurology, Klinikum Vest, Recklinghausen/Marl, Germany.
authors.forename: Rüdiger
authors.initials: R
authors.lastname: Hilker
authors.affiliation: Department of Neurology, Lindenbrunn Hospital, Lindenbrunn 1, 31863, Coppenbrügge, Germany.|Department of Neurology, University Hospital Freiburg, Breisacher Str. 64, 79106, Freiburg, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Winkler
authors.affiliation: Nervenarztpraxis Gerresheim, Düsseldorf, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Lorrain
authors.affiliation: Clinic of Neurology Bad Neustadt, Academic Teaching Hospital of the University Marburg, 97616, Bad Neustadt, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Hahne
authors.affiliation: Hans-Berger-Department of Neurology, Jena University Hospital, Jena, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Redecker
authors.affiliation: Department of Neurology, University Medicine Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany.
authors.forename: Paul
authors.initials: P
authors.lastname: Lingor
authors.affiliation: Parkinson-Klinik, Wolfach, Germany.
authors.forename: Wolfgang H
authors.initials: WH
authors.lastname: Jost
mesh_terms: D000978:Antiparkinson Agents / Q000009:adverse effects*; D046690:Deep Brain Stimulation / Q000379:methods*; D006801:Humans; D010300:Parkinson Disease / Q000628:therapy*; D018579:Patient Selection; D018802:Patient-Centered Care
chemical_list: D000978:Antiparkinson Agents
keywords: Apomorphine; Deep brain stimulation; Levodopa-carbidopa intestinal gel; Motor complications; Parkinson’s disease; Patient-centred care