Sensors help assess Parkinson’s patients for apomorphine therapy
Wearable sensors monitor motor symptoms to help gauge treatment suitability
Wearable sensors that monitor motor symptoms like tremor can accurately assess eligibility of Parkinson’s disease patients for apomorphine pump therapy, aligning closely with traditional clinical evaluations, according to a study.
The findings suggest that wearable sensors have “the potential to revolutionize the way patients are assessed and treated, ultimately improving their quality of life,” the researchers wrote. Certain patients should still be offered in-person consultations, with wearable sensors and remote assessments serving as a “complementary, rather than a replacement option, thereby providing more flexible care alternatives,” they wrote.
The study, “Assessing Eligibility for Apomorphine Therapy in Parkinson’s Disease: The Telemonitoring Potential,” was published in Movement Disorders.
Parkinson’s disease is caused by the gradual degeneration of nerve cells responsible for producing dopamine, a chemical messenger crucial for regulating muscle movements. Parkinson’s first-line treatment involves the use of levodopa and related medications designed to boost dopamine levels in the brain. But with prolonged use, their effectiveness can diminish, leading to the recurrence of symptoms between doses, known as off episodes. Patients may also experience involuntary, unpredictable movements, known as dyskinesia.
To manage these complications, patients often need second-line therapies such as apomorphine, which mimics dopamine’s function in the brain. Apokyn is an apomorphine formulation that has been approved in the U.S. for on-demand use to reduce off episodes since 2004. This formulation is administered via under-the-skin (subcutaneous) injection using a pen.
Apomorphine for Parkinson’s
A continuous subcutaneous infusion of apomorphine using a specialized pump, Onapgo, was approved in the U.S. recently to reduce motor symptom fluctuations. A similar therapy, APO-go, has been available in Europe since the 1990s. Onapgo’s delivery method allows for improved symptom control while requiring fewer injections than Apokyn.
There are guidelines that can help identify advanced Parkinson’s patients who need alternative treatments to levodopa, but the process is complex and usually depends on physician expertise and relies on patient referrals.
“The continuous recording of motor symptoms presents a valuable framework for physicians, providing objective quantitative measures that can serve as a complementary stratification tool for the selection of advanced-therapy candidates, in addition to established guidelines,” the researchers wrote.
Wearable technology has shown promise in monitoring motor symptoms in home settings. While these technologies support long-term Parkinson’s management, their role in selecting candidate patients for device-assisted strategies has not been studied in depth.
A team led by researchers in the U.K. and Greece evaluated the effectiveness of PD Neurotechnology’s PDMonitor system in facilitating patient referrals for continuous apomorphine infusion. They also compared objective motor symptom tracking with traditional clinical assessment to improve the selection process for advanced Parkinson’s therapies.
The PDMonitor system uses five wearable sensors placed on the waist, legs and forearms. Patients wear the devices during waking hours and then dock them for data transfer and recharging. The system measures basic daily activities (walking, resting/sitting, lying) and motor symptoms (tremor; bradykinesia, or slowness of movement; gait; and balance impairments).
The researchers set out to determine the eligibility of 20 Parkinson’s disease patients for apomorphine pump treatment. A multi-disciplinary team consisting of a nurse, neurologist, and geriatrician, reviewed both telemonitoring data and physical examinations to make their decisions. Separately, a blind rater algorithm assessed eligibility using only telemonitoring data from the PDMonitor system.
The results showed a high level of agreement between the team and the blind rater in determining eligibility for apomorphine pump treatment, with a 95% agreement rate and a Cohen’s kappa coefficient of 0.89. A Cohen’s kappa coefficient is a statistical measure used to evaluate the level of agreement between methods. It ranges from -1 to 1, where 1 indicates perfect agreement.
The findings suggest that results from wearable sensors and telemonitoring align closely with traditional clinical evaluations.
Patients used the device for 12.8 hours per day, on average, and it revealed key differences between those patients eligible for apomorphine therapy and those who were not.
Patients in the APO group exhibited significantly higher dyskinesia and lower on time, or periods when motor symptoms are well controlled. On average, the device-reported percentage of time in the on state for apomorphine-eligible patients was 24.9, compared with 59.6 in the non-APO group.
“Using telemonitoring to determine eligibility for apomorphine therapy might improve evaluation and treatment in patients with PD [Parkinson’s disease] and, therefore help improve their quality of life,” the researchers concluded.
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