title: Practical approaches to commencing device-assisted therapies for Parkinson disease in Australia.
abstract: In Australia 1% of individuals aged over 50 years have Parkinson disease (PD). Guidance for commencing device-assisted therapies (DAT) for PD in Australia was developed based on a review of European recommendations and their relevance to the local clinical setting. An online survey and teleconference discussions were held by a group of eight local movement disorder experts to develop consensus. Referral to a movement disorder specialist and consideration of DAT is appropriate when motor fluctuations cause disability or reduced quality of life, response to treatment is inconsistent or motor fluctuations and dyskinesias require frequent treatment adjustment without apparent benefit and levodopa is required four or more times daily. Three types of DAT are available in Australia for patients with PD: continuous subcutaneous apomorphine; continuous levodopa-carbidopa intestinal gel infusion; and deep brain stimulation. All improve consistency of motor response. The most important aspects when considering which DAT to use are the preferences of the patient and their carers, patient comorbidities, age, cognitive function and neuropsychiatric status. Patients and their families need to be provided with treatment options that are suitable to them, with adequate explanations regarding the recommendations and comparison of potential device-related complications. DAT are best managed, where possible, in a specialist centre with experience in all three types of therapy. Proactive and early management of symptoms during disease progression is essential to maintain optimally motor responses and quality of life in patients with PD.
authors.affiliation: Faculty of Medicine Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia.
authors.forename: David R
authors.initials: DR
authors.lastname: Williams
authors.affiliation: Neurology Department, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.
authors.forename: Andrew H
authors.initials: AH
authors.lastname: Evans
authors.affiliation: Movement Disorders Unit, Department of Neurology, Westmead Hospital and Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Victor S C
authors.initials: VSC
authors.lastname: Fung
authors.affiliation: Department of Neuroscience, Concord Hospital, Sydney, New South Wales, Australia.
authors.forename: Michael
authors.initials: M
authors.lastname: Hayes
authors.affiliation: CRC for Movement Disorders and Gait Kingston Centre Monash Health, School of Clinical Sciences, Monash University, Melbourne, Victoria, Australia.
authors.forename: Robert
authors.initials: R
authors.lastname: Iansek
authors.affiliation: Neurology Unit, Royal Adelaide Hospital, Department of Medicine, University of Adelaide, Adelaide, South Australia, Australia.
authors.forename: Thomas
authors.initials: T
authors.lastname: Kimber
authors.affiliation: School of Medicine, University of Queensland, Brisbane, Queensland, Australia.
authors.forename: John D
authors.initials: JD
authors.lastname: O'Sullivan
authors.affiliation: Department of Neurology, Royal North Shore Hospital, University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Carolyn M
authors.initials: CM
authors.lastname: Sue
mesh_terms: D000978:Antiparkinson Agents / Q000008:administration & dosage*; D001058:Apomorphine / Q000008:administration & dosage; D001315:Australia / Q000453:epidemiology; D002230:Carbidopa / Q000008:administration & dosage; D046690:Deep Brain Stimulation / Q000379:methods*; D004338:Drug Combinations; D006801:Humans; D007263:Infusions, Parenteral / Q000379:methods*; D055104:Infusions, Subcutaneous / Q000379:methods*; D007980:Levodopa / Q000008:administration & dosage; D010300:Parkinson Disease / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology*
chemical_list: D000978:Antiparkinson Agents; D004338:Drug Combinations; C009265:carbidopa, levodopa drug combination; D007980:Levodopa; D002230:Carbidopa; D001058:Apomorphine
keywords: Parkinson disease; apomorphine; carbidopa levodopa drug combination; deep brain stimulation; dyskinesias