Parkinson s disease (PD) is a common and complex
|
|
- Charla Berry
- 5 years ago
- Views:
Transcription
1 n reports n Implications for Managed Care for Improving Outcomes in Parkinson s Disease: Balancing Aggressive Treatment With Appropriate Care Jack J. Chen, PharmD, FCCP, BCPS, CGP Abstract Disability in Parkinson s disease (PD) is due not only to progressive impairment in balance, gait, and motor-related tasks, but also to several nonmotor symptoms affecting autonomic, neuropsychiatric, and sensory functions. The prevalence of PD in the United States is rising due to the expanding elderly population. Direct medical costs associated with PD are significant and influenced by level of disability and associated complexity of management. As new treatments are made available, reevaluation of treatment benefits and paradigms is warranted, for both motor and nonmotor symptoms of PD, to better manage outcomes. In addition to evaluation of symptomatic therapies for PD, attention to advances in disease-modifying therapies and to management of nonmotor symptoms should be an integral component of PD surveillance in the managed care environment. (Am J Manag Care. 2011;17:S322-S327) For author information and disclosures, see end of text. Parkinson s disease (PD) is a common and complex movement disorder characterized by progressive neurodegeneration, loss of nigrostriatal dopaminergic and extranigral neurons, and functional disability due to motor and nonmotor symptoms. 1 Variability in PD phenotype and progression is well recognized and serves as the basis for individualizing patient therapy. Over the lifetime course of PD, shifts in individual therapeutic response, emergence of drug-related adverse effects and motor complications, development of levodopa-unresponsive symptoms, and the onset of additional PD-related nonmotor symptoms add to the complexity of patient management, and constant, ongoing modification of pharmacotherapy should be expected. Disability in PD Managed Care & Healthcare Communications, LLC is due not only to progressive impairment in balance, gait, and movement-related tasks, but also to several nonmotor symptoms affecting autonomic, neuropsychiatric, and sensory functions. 1 The goal of therapy for PD is to improve outcomes in domains of motor and nonmotor symptoms, activities of daily living, and quality of life (QOL), while minimizing acute and long-term side effects. The prevalence of PD in the United States is rising due to the expanding elderly population and the number of individuals with PD is expected to double in the next 20 years. 2 Such an increase will likely place a significant burden on care systems and caregivers given the associated disability and amount of caregiving required for this patient population. Additionally, it can be anticipated that PD will continue to be associated with significant direct and indirect economic costs due to symptom management and disability. Direct medical costs associated with PD are significant and influenced by level of disability and associated complexity of management. 3 As new treatments are made available, reevaluation of treatment benefits and paradigms is warranted, for both motor and nonmotor symptoms of PD, to better manage outcomes. Economic and Quality of Life Issues in PD The introduction of levodopa in 1967 was a significant advance in PD therapy and improved QOL for treated patients with PD. However, despite therapy, patients with PD continue to experience deterioration in QOL with disease progression. Additionally, S322 n n october 2011
2 Balancing Aggressive Treatment With Appropriate Care even levodopa-treated patients develop considerable disability after 5 to 10 years of disease despite expert treatment with available medications. 3 In particular, the development of gait/balance disturbances and dementia (all of which are generally unresponsive to dopaminergic therapy) significantly increases the mortality risk due to complications (eg, immobility, falls, and nursing home placement). 3 The annual economic impact of PD in the United States is estimated at $10.8 billion, 58% of which is related to direct medical costs. 4 Annual direct medical costs per patient with PD are estimated at between $10,043 and $12,491 while annual indirect costs are estimated at $25,326 per patient. Nursing home care is the largest component of direct medical costs at approximately 40%, while prescription drugs account for 20% or less. Although more difficult to measure, annual indirect costs for both patients and caregivers, including lost wages due to termination or early retirement and switching to individual health insurance, can be very significant. In 1 study, Medicare Part D beneficiaries with PD were found to repeatedly reach the drug benefit threshold due to greater utilization of brand-name medications for which there were limited available generic alternatives. 5 Levodopa, which is one of the most effective medications for PD, is available generically; however, clinicians and payers should keep in mind that long-term treatment is unfortunately associated with the development of motor complications (eg, dyskinesias and fluctuations), which may necessitate the use of adjunctive medical and surgical therapies, all of which ultimately increase direct and indirect economic costs. When evaluating drug economics, thoughtful consideration should be given to not only the issue of generic and brand-name availability and cost, but also to short- and long-term effects. Payer and provider plans do make a difference in patient satisfaction and QOL. In a recently published European study, QOL was reported to be better in patients with PD who had private insurance compared with patients with PD who had government-provided insurance. 6 Just as statistically significant differences are important to consider when evaluating the validity of research data, clinically significant differences are important for determining therapeutic value. Likewise, just as economically significant differences in drug cost are important to consider when evaluating formulary placement, QOL significance must also be considered. Even though drugs comprise a smaller proportion of direct costs, the associated QOL benefits due to delayed disability (motor and nonmotor) and maintenance of employability and independence can be significant and must be considered. QOL considerations extend and portray the impact of therapy beyond what can be described by statistical and economic parameters. Not only motor symptoms but also nonmotor symptoms (eg, dementia, depression, orthostatic hypotension, sleep disorders, urinary dysfunction) have a significant negative effect on health-related QOL; oftentimes more so than motor symptoms. 7 In 1 study, utilizing a large Veterans Administration cohort, patients with PD exhibited lower scores on the physical and mental health dimensions of health-related QOL compared with patients with 8 other neurological or chronic conditions, including angina/coronary heart disease, congestive heart failure, diabetes, and stroke. 8 Clinical Course and Diagnostic Issues in PD The clinical course of PD is postulated to be characterized by a prodromal phase characterized by nonmotor symptoms such as constipation, hyposmia (smell impairment), and rapid eye movement sleep behavior disorder. 1 Such symptoms may occur up to 10 years prior to motor symptoms and diagnosis. Given increased knowledge of the premotor phenotype of PD, a battery of tests including assessment of nonmotor features, olfactory testing, and neuroimaging may one day provide a means of reliably diagnosing PD at an early stage of the disease. Currently, clinical diagnosis is based on the presence of obvious motor features consisting of bradykinesia (slowness of movement), tremor, and/or rigidity. 1 As PD progresses, patients exhibit disability due to bradykinesia, rigidity, gait and balance difficulty, and falls. In particular, the onset of balance impairment, falling, or cognitive impairment is a hallmark of disability. Side effects (eg, daytime sleepiness, orthostatic hypotension, psychosis) and long-term effects due to pharmacotherapy (eg, levodopa-related dyskinesias, motor fluctuations, neuropsychiatric complications, dopamine-agonist induced hallucinations) also often complicate therapy. For clinically indeterminate cases, some clinicians will provide an acute levodopa challenge or a brief trial of levodopa as a means of diagnosis. However, in the United States, this method is not routinely recommended. 9 Acute exposure to a therapeutic dose of levodopa can expose the patient to an unnecessary risk of adverse effects. Additionally, if the patient experiences a positive clinical response to levodopa, the patient and clinician are in essence committed to levodopa as the main form of therapy, and the patient is not likely to accept non-levodopa agents as monotherapy. For clinically indeterminate cases, referral to a movement disorders specialist or use of neuroimaging can be recommended. Recently, a radioligand to measure presynaptic dopamine transporters with single photon emission computed VOL. 17, No. 12 n The American Journal of Managed Care n S323
3 Reports tomography (SPECT) has become commercially available in the United States. The DaTscan is a striatal SPECT imaging method utilizing ioflupane iodine-123 as a diagnostic aid and has demonstrated good sensitivity and specificity for detecting striatal dopamine deficiency. 10 However, the imaging results do not differentiate between the various dopamine deficiency disorders (such as idiopathic PD from atypical parkinsonism or dementia with Lewy bodies) and should be considered as an adjunct to findings from the clinical assessment and history. However, in clinically indeterminate cases, the imaging method can differentiate between intrinsic parkinsonism and other disorders such as drug-induced parkinsonism, dystonic tremor, essential tremor, normal pressure hydrocephalus, psychogenic parkinsonism, Wilson s disease, and various gait disorders of the elderly, all of which may mimic PD but are not associated with dopamine deficiency. Although disease progression is patient-specific and highly variable, ultimately all patients with PD will require symptomatic therapy, and eventually, all patients will end up on a levodopa-based regimen. It is generally accepted that younger patients treated with levodopa are at greater risk of developing motor fluctuations and dyskinesias as compared with older patients; therefore, if symptoms are mild to moderate, the use of non-levodopa regimens is preferable in younger patients. 11 Even with optimal drug therapy, many patients will develop balance and gait impairment as the disease progresses, and simple activities such as ambulating around the house to accomplish activities of daily living as well as traveling in the community for leisure, recreational, and social activities will become prohibitively difficult. The onset of such disability also has a significant impact on caregivers, because at this point caregivers become increasingly involved. Management of PD The goal of the management of PD is to improve motor and nonmotor symptoms so that patients are able to obtain the best function for their stage of disease. For most community-dwelling patients, this means preserving the ability to perform instrumental activities of daily living, independent living, and QOL in all domains (eg, physical, psychological, social). With the progression of motor and nonmotor symptom severity, the onset of disability, and greater dependence on caregiver assistance, the emphasis will shift to preserving basic activities of daily living and specific QOL domains that are important to the patient. Ultimately, with advanced PD, therapeutic goals will shift to a focus on providing palliative therapy. At various stages of the disease, non-pharmacologic interventions (eg, occupational, physical, and speech therapy) also play a vital role. Specific objectives to consider when selecting an intervention include preservation of the ability to perform activities of daily living; improvement of mobility, gait, and balance; minimization of adverse effects; treatment complications; putative disease modification; and management of nonmotor features such as cognitive impairment, depression, fatigue, orthostasis, and daytime and nighttime sleep disorders. To accomplish some of these objectives, consultation with a specialist (eg, in movement disorders, physical therapy, psychiatry, sleep medicine) is helpful. Once a correct diagnosis of PD is made, nonpharmacologic and pharmacologic interventions must be considered. Treatment guidelines and parameters are updated frequently to reflect new information and changes in treatment paradigms. 1 A general treatment approach for the treatment of early and advanced PD is illustrated in the Figure. 12 Accumulating evidence demonstrates that exercise in patients with PD results in improvement in function, gait, and QOL. 13 However, what constitutes the best type of exercise is still an open question. A physical therapist can assist in balance, gait, endurance, and strength training. Patients with PD should be encouraged to resume or continue physical exercise for as long as possible. Examples of exercise or mobility activities include bicycling, golfing, swimming, tennis, walking (conventional or treadmill), and even playing interactive, virtual reality, motion-controlled video games. A recent development is the use of rasagiline, a monoamine oxidase B (MAO-B) inhibitor, in patients with early PD who have minimal functional impairment. Large randomized, double-blinded, placebo-controlled studies, such as the TEMPO (TVP-1012 in Early Monotherapy for PD Outpatients) delayed start and the ADAGIO (Attenuation of Disease Progression with Azilect Given Once-Daily) delayed start studies, demonstrate that initiation of rasagiline in early stage PD slows the decline of motor function and is well tolerated. 14,15 The definition of functional impairment is highly patient specific. Factors such as comorbid conditions, cognitive status, employment, lifestyle, and patients desires must be considered when initiating pharmacotherapy. In a physiologically young patient experiencing minimal to mild functional impairment, monotherapy with amantadine, dopamine agonists, levodopa, or rasagiline can be considered. For mild to moderate impairment, a dopamine agonist is preferred, and for severe impairment, levodopa should be considered. For patients who are older or cognitively impaired, rasagiline (for mild impairment) or levodopa (for moderate to severe S324 n n october 2011
4 Balancing Aggressive Treatment With Appropriate Care n Figure. General Approach to the Management of Parkinson s Disease 12 Diagnosis of Parkinson s disease Nonpharmacologic therapy: Education, exercise, nutrition, psychosocial support Pharmacologic therapy for motor symptoms rasagiline Management of nonmotor symptoms a <65 years b anticholinergic or amantadine Need for additional symptomatic control Tremor >65 years b amantadine dopamine agonist or carbidopa/levodopa Bradykinesia, rigidity, tremor carbidopa/levodopa Management of motor fluctuations: Increase dosing frequency of levodopa Add MAO-B inhibitor or COMT inhibitor Add a dopamine agonist Management of peak-dose dyskinesia: Reduce dopaminergic drug dose Add amantadine Need for more symptomatic control of motor complications (despite optimized pharmacotherapy): surgery COMT indicates catechol-o-methyltransferase; MAO-B, monoamine oxidase B. a Nonmotor symptoms include anxiety, cognitive impairment, constipation, depression, dysphagia, orthostatic hypotension, sialorrhea, sleep disorders, speech impairment, and urinary incontinence. b Age is not the sole determinant of drug choice. Others factors such as cognitive function and overall safety and tolerability of drug should be considered, especially in the elderly. Adapted from Chen JJ, Nelson MV, Swope DM. Parkinson s disease. In: DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey IM, eds. Pharmacotherapy: A Pathophysiologic Approach. 8th ed. New York, NY: McGraw Hill; 2011: impairment) are preferred. Ultimately, all patients will require the use of levodopa, either as monotherapy or in combination with other agents. With chronic levodopa therapy, patients may begin to experience motor fluctuations, and the American Academy of Neurology assigns a high level of evidence for the addition of entacapone or rasagiline to extend the duration of activity of levodopa. 16 For management of levodopa-induced peak-dose dyskinesias, the addition of amantadine should be considered. Surgery is considered only in patients who need more symptomatic control or who are experiencing severe motor complications despite pharmacologically optimized therapy. In summary, individual treatment plans will evolve as the disease progresses, and must include consideration of short-term symptomatic relief as well as long-term effects. VOL. 17, No. 12 n The American Journal of Managed Care n S325
5 Reports Patient-specific factors that guide selection of therapies include the functional age of the patient, the patient s desired outcomes, cognitive status, the severity of motor features, and response to any previous PD therapies. Patient education should be communicated with realistic optimism. For example, it should be explained that although there is no cure for PD, modern medicine has many medications that can provide relief of symptoms. Nonpharmacologic interventions such as exercise should be encouraged, and nonmotor features of PD should not be neglected. Disease-Modifying Agents To date, several clinical trials have investigated the disease-modifying effects of various agents. The results of many studies have been disappointing However, the ADAGIO study 15 yielded promising results. The ADAGIO study is the largest study to specifically evaluate for disease modification in PD. The prospective, multicenter, placebo-controlled, double-blind clinical study had a delayed-start design developed to assess the efficacy of rasagiline as a disease-modifying compound in patients with early, non-disabling PD. The ADAGIO study was initiated based on results from a preliminary study which suggested that rasagiline given early in the disease might have disease-modifying benefits. 14 Patients in the ADAGIO study who received rasagiline 1 mg/day demonstrated a slower rate of disease progression compared with patients in the placebo group. Based on the efficacy and safety results of ADAGIO, there is some evidence to support the initiation of treatment with rasagiline in early PD. The outcomes associated with rasagiline should not be considered a class effect of MAO-B inhibitors; more trials are needed to help determine if there is a class effect. Specifically, the results of ADAGIO should not be extrapolated to selegiline, another commercially available MAO-B inhibitor. Selegiline is metabolized to the amphetamine derivatives L-methamphetamine and L-amphetamine, which are present in sufficient concentrations to produce toxic effects in experimental models and side effects in patients with PD. 20 Additionally, recent data suggest that chronic amphetamine use is associated with an increased lifetime risk of PD. 21 Conclusion Parkinson s disease is associated with significant direct and indirect medical costs and impaired QOL. Differences in managed care and insurance plans affect clinical care, which in turn affects patient outcomes and QOL. Periodic attention to new data on short- and long-term clinical efficacy and safety, disease modification, and nonmotor symptoms associated with PD will allow clinicians and payers to optimize management and care plans for patients with PD. Author Affiliations: Department of Pharmacotherapy and Outcomes Science, Department of Neurology, School of Medicine, Loma Linda University, Loma Linda, CA. Funding Source: This activity is supported by an educational grant from Teva Neuroscience, Inc. Author Disclosure: Dr Chen reports serving as an advisory board member/consultant for and receiving honoraria from Chelsea Pharmaceuticals and Teva Neuroscience, Inc. He has served on the speaker s bureau for Teva Neuroscience, Inc. Authorship Information: Concept and design; acquisition of data; analysis and interpretation of data; drafting of the manuscript; and critical revision of the manuscript for important intellectual content. Address correspondence to: jjchen@llu.edu. REFERENCES 1. Olanow CW, Stern MB, Sethi K. The scientific and clinical basis for the treatment of Parkinson disease. Neurology. 2009;72(21 suppl 4):S1-S Dorsey ER, Constantinescu R, Thompson JP, et al. Projected number of people with Parkinson disease in the most populous nations, 2005 through Neurology. 2007;68: Chen JJ. Parkinson s disease: health-related quality of life, economic cost, and implications of early treatment. Am J Manag Care. 2010;16:S87-S O Brien JA, Ward A, Michels SL, Tzivelekis S, Brandt NJ. Economic burden associated with Parkinson Disease. Drug Benefit Trends. 2009;21: Bayliss EA, Ellis JL, Delate T, Steiner JF, Raebel MA. Characteristics of Medicare Part D beneficiaries who reach the drug benefit threshold in both of the first two years of the Part D benefit. Med Care. 2010;48: Müller T, Woitalla D. Quality of life, caregiver burden and insurance in patients with Parkinson s disease in Germany. Eur J Neurol. 2010;17: Soh SE, Morris ME, McGinley JL. Determinants of health-related quality of life in Parkinson s disease: a systematic review. Parkinsonism Relat Disord. 2011;17: Gage H, Hendricks A, Zhang S, Kazis L. The relative health related quality of life of veterans with Parkinson s disease. J Neurol Neurosurg Psychiatry. 2003;74: Clarke CE, Davies P. Systematic review of acute levodopa and apomorphine challenge tests in the diagnosis of idiopathic Parkinson s disease. J Neurol Neurosurg Psychiatry. 2000;69: Stoessl AJ. Neuroimaging in Parkinson s disease. Neurotherapeutics. 2011;8: Chen JJ, Swope DM. Pharmacotherapy for Parkinson s disease. Pharmacotherapy. 2007;27(12, pt 2):161S-173S. 12. Chen JJ, Nelson MV, Swope DM. Parkinson s disease. In: DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey IM, eds. Pharmacotherapy: A Pathophysiologic Approach. 8th ed. New York, NY: McGraw Hill; 2011: Speelman AD, van de Warrenburg BP, van Nimwegen M, Petzinger GM, Munneke M, Bloem BR. How might physical activity benefit patients with Parkinson disease? Nat Rev Neurol. 2011;7(9): Parkinson Study Group. A controlled, randomized, delayedstart study of rasagiline in early Parkinson disease. Arch Neurol. 2004;61: Olanow CW, Rascol O, Hauser R, et al; for the ADAGIO Study Investigators. A double-blind, delayed-start trial of rasagiline in Parkinson s disease. N Engl J Med. 2009;361: S326 n n october 2011
6 Balancing Aggressive Treatment With Appropriate Care 16. Pahwa R, Factor SA, Lyons KE, et al. Practice Parameter: treatment of Parkinson disease with motor fluctuations and dyskinesia (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2006;66: Parkinson Study Group. Effects of tocopherol and deprenyl on the progression of disability in early Parkinson s disease. N Eng J Med. 1993;328: Schapira A, Albrecht S, Barone P, et al. Immediate vs. delayedstart pramipexole in early Parkinson s disease: the PROUD study. Parkinsonism Relat Disord. 2009;15(suppl 2):S Parkinson s Disease Foundation. Co-enzyme Q10 study stopped because of lack of evidence that it delays progression of early PD. Accessed July 28, Bar Am O, Amit T, Youdim MB. Contrasting neuroprotective and neurotoxic actions of respective metabolites of anti-parkinson drugs rasagiline and selegiline. Neurosci Lett. 2004;355: Van Den Eeden SK, Tanner CM, Albers KS, et al. Amphetamine use and risk of Parkinson s disease in a prospective study. Neurology. 2011;76(suppl 4):A362 (abstract). VOL. 17, No. 12 n The American Journal of Managed Care n S327
Prior Authorization with Quantity Limit Program Summary
Gocovri (amantadine) Prior Authorization with Quantity Limit Program Summary This prior authorization applies to Commercial, NetResults A series, SourceRx and Health Insurance Marketplace formularies.
More informationProgram Highlights. Michael Pourfar, MD Co-Director, Center for Neuromodulation New York University Langone Medical Center New York, New York
Program Highlights David Swope, MD Associate Professor of Neurology Mount Sinai Health System New York, New York Michael Pourfar, MD Co-Director, Center for Neuromodulation New York University Langone
More information10th Medicine Review Course st July Prakash Kumar
10th Medicine Review Course 2018 21 st July 2018 Drug Therapy for Parkinson's disease Prakash Kumar National Neuroscience Institute Singapore General Hospital Sengkang General Hospital Singhealth Duke-NUS
More informationFaculty. Joseph Friedman, MD
Faculty Claire Henchcliffe, MD, DPhil Associate Professor of Neurology Weill Cornell Medical College Associate Attending Neurologist New York-Presbyterian Hospital Director of the Parkinson s Institute
More informationTreatment of Parkinson s Disease: Present and Future
Treatment of Parkinson s Disease: Present and Future Karen Blindauer, MD Professor of Neurology Director of Movement Disorders Program Medical College of Wisconsin Neuropathology: Loss of Dopamine- Producing
More informationRe-Submission. Scottish Medicines Consortium. rasagiline 1mg tablet (Azilect ) (No. 255/06) Lundbeck Ltd / Teva Pharmaceuticals Ltd.
Scottish Medicines Consortium Re-Submission rasagiline 1mg tablet (Azilect ) (No. 255/06) Lundbeck Ltd / Teva Pharmaceuticals Ltd 10 November 2006 The Scottish Medicines Consortium (SMC) has completed
More informationEvaluation of Parkinson s Patients and Primary Care Providers
Evaluation of Parkinson s Patients and Primary Care Providers 2018 Movement Disorders Half Day Symposium Elise Anderson MD Medical Co-Director, PBSI Movement Disorders 6/28/2018 1 Disclosures GE Speaker,
More informationOverview. Overview. Parkinson s disease. Secondary Parkinsonism. Parkinsonism: Motor symptoms associated with impairment in basal ganglia circuits
Overview Overview Parkinsonism: Motor symptoms associated with impairment in basal ganglia circuits The differential diagnosis of Parkinson s disease Primary vs. Secondary Parkinsonism Proteinopathies:
More informationAnticholinergics. COMT* Inhibitors. Dopaminergic Agents. Dopamine Agonists. Combination Product
Drug Use Research & Management Program Oregon State University, 500 Summer Street NE, E35, Salem, Oregon 97301-1079 Phone 503-945-5220 Fax 503-947-1119 Class Update: Parkinson s Drugs Month/Year of Review:
More informationOptimizing Clinical Communication in Parkinson s Disease:
Optimizing Clinical Communication in Parkinson s Disease:,Strategies for improving communication between you and your neurologist PFNCA Symposium March 25, 2017 Pritha Ghosh, MD Assistant Professor of
More informationClinical Policy: Safinamide (Xadago) Reference Number: CP.CPA.308 Effective Date: Last Review Date: Line of Business: Commercial
Clinical Policy: Safinamide (Xadago) Reference Number: CP.CPA.308 Effective Date: 05.16.17 Last Review Date: 08.17 Line of Business: Commercial Revision Log See Important Reminder at the end of this policy
More informationEvaluation and Management of Parkinson s Disease in the Older Patient
Evaluation and Management of Parkinson s Disease in the Older Patient David A. Hinkle, MD, PhD Comprehensive Movement Disorders Clinic Pittsburgh Institute for Neurodegenerative Diseases University of
More informationTRANSPARENCY COMMITTEE OPINION. 18 March 2009
The legally binding text is the original French version TRANSPARENCY COMMITTEE OPINION 18 March 2009 REQUIP LP 2 mg extended-release tablet Box of 21 tablets (CIP: 379 214-8) Box of 28 tablets (CIP: 379
More informationWelcome and Introductions
Parkinson s Disease Spotlight on Treatment Advances Tuesday, January 26, 2016 Welcome and Introductions Stephanie Paul Vice President Development and Marketing American Parkinson Disease Association 1
More informationPharmacologic Treatment of Parkinson s Disease. Nicholas J. Silvestri, M.D. Associate Professor of Neurology
+ Pharmacologic Treatment of Parkinson s Disease Nicholas J. Silvestri, M.D. Associate Professor of Neurology + Disclosures n NO SIGNIFICANT FINANCIAL, GENERAL, OR OBLIGATION INTERESTS TO REPORT + Learning
More informationPARKINS ON CENTER. Parkinson s Disease: Diagnosis and Management. Learning Objectives: Recognition of PD OHSU. Disclosure Information
OHSU PARKINS ON CENTER Parkinson s Disease: Diagnosis and Management for Every MD Disclosure Information Grants/Research Support: National Parkinson Foundation, NIH, Michael J. Fox Foundation Consultant:
More informationBest Medical Treatments for Parkinson s disease
Best Medical Treatments for Parkinson s disease Bernadette Schöneburg, M.D. June 20 th, 2015 What is Parkinson s Disease (PD)? Progressive neurologic disorder that results from the loss of specific cells
More informationPharmacologic Treatment of Parkinson s Disease. Nicholas J. Silvestri, M.D. Assistant Professor of Neurology
+ Pharmacologic Treatment of Parkinson s Disease Nicholas J. Silvestri, M.D. Assistant Professor of Neurology + Overview n Brief review of Parkinson s disease (PD) n Clinical manifestations n Pathophysiology
More informationWHAT DEFINES YOPD? HANDLING UNIQUE CONCERNS REBECCA GILBERT, MD, PHD VICE PRESIDENT, CHIEF SCIENTIFIC OFFICER, APDA MARCH 14, 2019
WHAT DEFINES YOPD? HANDLING UNIQUE CONCERNS REBECCA GILBERT, MD, PHD VICE PRESIDENT, CHIEF SCIENTIFIC OFFICER, APDA MARCH 14, 2019 YOUNG ONSET PARKINSON S DISEASE Definition: Parkinson s disease diagnosed
More informationCENTENE PHARMACY AND THERAPEUTICS NEW DRUG REVIEW 3Q17 July August
BRAND NAME Xadago GENERIC NAME Safinamide MANUFACTURER Newron Pharmaceuticals SpA holds license; granted approval. US WorldMeds, LLC exclusive licensee and distributor in the U.S. DATE OF APPROVAL March
More information2-The age at onset of PD is variable, usually between 50 and 80 years, with a mean onset of 55 years (1).
Parkinson Disease 1-Parkinson disease (PD) is a chronic, progressive movement disorder resulting from loss of dopamine from the nigrostriatal tracts in the brain, and is characterized by rigidity, bradykinesia,
More informationPresented by Meagan Koepnick, Josh McDonald, Abby Narayan, Jared Szabo Mentored by Dr. Doorn
Presented by Meagan Koepnick, Josh McDonald, Abby Narayan, Jared Szabo Mentored by Dr. Doorn Objectives What agents do we currently have available and what do we ideally need? What biomarkers exist for
More informationDrug Therapy of Parkinsonism. Assistant Prof. Dr. Najlaa Saadi PhD Pharmacology Faculty of Pharmacy University of Philadelphia
Drug Therapy of Parkinsonism Assistant Prof. Dr. Najlaa Saadi PhD Pharmacology Faculty of Pharmacy University of Philadelphia Parkinsonism is a progressive neurological disorder of muscle movement, usually
More informationPD: Key Treatment Considerations
PD: Key Treatment Considerations 2018 Management of Neurologic and Neurosurgical Disorders in Daily Practice Elise Anderson MD Medical Co-Director, PBSI Movement Disorders 11/27/2018 1 Outline Treatment
More informationObjectives. Emerging Treatments in Parkinson s s Disease. Pathology. As Parkinson s progresses it eventually affects large portions of the brain.
Objectives Emerging Treatments in Parkinson s s Disease 1) Describe recent developments in the therapies for Parkinson s Disease Jeff Kraakevik MD Assistant Professor OHSU/Portland VAMC Parkinson s Center
More informationPa t h w a y s. Pa r k i n s o n s. MacMahon D.G. Thomas S. Fletcher P. Lee M. 2006
Pathways bolt 16/6/06 20:38 Page 1 Pa t h w a y s A PARADIGM FOR DISEASE MANAGEMENT IN Pa r k i n s o n s Disease MacMahon D.G. Thomas S. Fletcher P. Lee M. 2006 Clinical diagnosis Pa r k i n s o n s disease
More informationParkinson s Disease Current Treatment Options
Parkinson s Disease Current Treatment Options Daniel Kassicieh, D.O., FAAN Sarasota Neurology, P.A. PD: A Chronic Neurodegenerative Ds. 1 Million in USA Epidemiology 50,000 New Cases per Year Majority
More informationParkinson s disease Therapeutic strategies. Surat Tanprawate, MD Division of Neurology University of Chiang Mai
Parkinson s disease Therapeutic strategies Surat Tanprawate, MD Division of Neurology University of Chiang Mai 1 Scope Modality of treatment Pathophysiology of PD and dopamine metabolism Drugs Are there
More informationparts of the gastrointenstinal tract. At the end of April 2008, it was temporarily withdrawn from the US Market because of problems related to
parts of the gastrointenstinal tract. At the end of April 2008, it was temporarily withdrawn from the US Market because of problems related to crystallization of the drug, which caused unreliable drug
More informationWelcome and Introductions
Parkinson s Disease Spotlight on Addressing Motor and Non-Motor Symptoms The Changing Landscape Wednesday, March 8, 2017 Welcome and Introductions Stephanie Paul Vice President Development and Marketing
More informationParkinson s Disease Update
Parkinson s Disease Update Elise Anderson MD Providence Center for Parkinson s Disease October 26, 2017 11/6/2017 1 Disclosures GE Speaker, DaTSCAN 11/6/2017 2 Outline PD diagnosis Motor and nonmotor symptoms
More informationParkinson's Disease KP Update
Parkinson's Disease KP Update Andrew Imbus, PA-C Neurology, Movement Disorders Kaiser Permanente, Los Angeles Medical Center No disclosures "I often say now I don't have any choice whether or not I have
More informationUpdate in the Management of Parkinson s Disease
Update in the Management of Parkinson s Disease What s standard? What s new? What s coming? Bruno V. Gallo, M.D. Assistant Professor of Neurology, FIU Wertheim College of Medicine Director, Parkinson &
More informationDIFFERENTIAL DIAGNOSIS SARAH MARRINAN
Parkinson s Academy Registrar Masterclass Sheffield DIFFERENTIAL DIAGNOSIS SARAH MARRINAN 17 th September 2014 Objectives Importance of age in diagnosis Diagnostic challenges Brain Bank criteria Differential
More informationMotor Fluctuations Stephen Grill, MD, PHD Parkinson s and Movement Disorders Center of Maryland and Johns Hopkins University
Motor Fluctuations Stephen Grill, MD, PHD Parkinson s and Movement Disorders Center of Maryland and Johns Hopkins University I have no financial interest with any entity producing marketing, re-selling,
More informationReport on New Patented Drugs Azilect
Report on New Patented Drugs Azilect Under its transparency initiative, the PMPRB publishes the results of the reviews of new patented drugs by Board Staff, for purposes of applying the Board s Excessive
More informationParkinson s Disease Update. Presented by Joanna O Leary, MD Movement disorder neurologist Providence St. Vincent s
Parkinson s Disease Update Presented by Joanna O Leary, MD Movement disorder neurologist Providence St. Vincent s What is a movement disorder? Neurological disorders that affect ability to move by causing
More informationParkinson s Disease. Sirilak yimcharoen
Parkinson s Disease Sirilak yimcharoen EPIDEMIOLOGY ~1% of people over 55 years Age range 35 85 years peak age of onset is in the early 60s ~5% of cases characterized by an earlier age of onset (typically
More informationParkinson s Disease: initial diagnosis, initial treatment & non-motor features. J. Timothy Greenamyre, MD, PhD
Parkinson s Disease: initial diagnosis, initial treatment & non-motor features J. Timothy Greenamyre, MD, PhD Involuntary tremulous motion, with lessened muscular power, in parts not in action and even
More informationAdvanced Therapies for Motor Symptoms in PD. Matthew Boyce MD
Advanced Therapies for Motor Symptoms in PD Matthew Boyce MD Medtronic Education Teva Speakers Bureau Acadia Speakers Bureau Disclosures Discuss issues in advanced PD Adjunct therapies to levo-dopa Newer
More informationDisease Modification in Parkinson Disease: Are We There Yet? CME
Disease Modification in Parkinson Disease: Are We There Yet? CME Lawrence W. Elmer, MD, PhD Supported by an independent educational grant from View this activity online at: medscape.org/column/parkinson
More informationParkinson s Disease Medications: Professionals Edition
Parkinson s Disease Clinic and Research Center University of California, San Francisco 505 Parnassus Ave., Rm. 795-M, Box 0114 San Francisco, CA 94143-0114 (415) 476-9276 http://pdcenter.neurology.ucsf.edu
More informationRasagiline and Rapid Symptomatic Motor Effect in Parkinson s Disease: Review of Literature
Neurol Ther (2014) 3:41 66 DOI 10.1007/s40120-013-0014-1 REVIEW Rasagiline and Rapid Symptomatic Motor Effect in Parkinson s Disease: Review of Literature Michele Pistacchi Francesco Martinello Manuela
More informationScott J Sherman MD, PhD The University of Arizona PARKINSON DISEASE
Scott J Sherman MD, PhD The University of Arizona PARKINSON DISEASE LEARNING OBJECTIVES The Course Participant will: 1. Be familiar with the pathogenesis of Parkinson s Disease (PD) 2. Understand clinical
More information8/28/2017. Behind the Scenes of Parkinson s Disease
BEHIND THE SCENCES IN Parkinson s Disease Behind the Scenes of Parkinson s Disease Anna Marie Wellins DNP, ANP C Objectives Describe prevalence of Parkinson's disease (PD) Describe the hallmark pathologic
More informationDr Barry Snow. Neurologist Auckland District Health Board
Dr Barry Snow Neurologist Auckland District Health Board Dystonia and Parkinson s disease Barry Snow Gowers 1888: Tetanoid chorea Dystonia a movement disorder characterized by sustained or intermittent
More informationDrugs for Parkinson s Disease
This Clinical Resource gives subscribers additional insight related to the Recommendations published in July 2017 ~ Resource #330705 Drugs for Parkinson s Disease Parkinson s disease is characterized by
More informationTreatment of Parkinson s Disease and of Spasticity. Satpal Singh Pharmacology and Toxicology 3223 JSMBS
Treatment of Parkinson s Disease and of Spasticity Satpal Singh Pharmacology and Toxicology 3223 JSMBS singhs@buffalo.edu 716-829-2453 1 Disclosures NO SIGNIFICANT FINANCIAL, GENERAL, OR OBLIGATION INTERESTS
More informationCan Tango Help Improve Quality of Life for Patients with Parkinson s Disease?
Philadelphia College of Osteopathic Medicine DigitalCommons@PCOM PCOM Physician Assistant Studies Student Scholarship Student Dissertations, Theses and Papers 2018 Can Tango Help Improve Quality of Life
More informationPARKINSON S PRIMER. Dr. Kathryn Giles MD, MSc, FRCPC Cambridge, Ontario, Canada
PARKINSON S PRIMER Dr. Kathryn Giles MD, MSc, FRCPC Cambridge, Ontario, Canada COPYRIGHT 2017 BY SEA COURSES INC. All rights reserved. No part of this document may be reproduced, copied, stored, or transmitted
More informationWhat is the best medical therapy for early Parkinson's disease? Medications Commonly Used for Parkinson's Disease
FPIN's Clinical Inquiries Treatment of Early Parkinson's Disease Clinical Question What is the best medical therapy for early Parkinson's disease? Evidence-Based Answer Treatment of early Parkinson's disease
More informationThe Shaking Palsy of 1817
The Shaking Palsy of 1817 A Treatment Update on Parkinson s Disease Dr Eitzaz Sadiq Neurologist CH Baragwanath Acadamic Hospital Parkinson s Disease O Premature death of dopaminergic neurons O Symptoms
More informationFOR PARKINSON S DISEASE XADAGO NEXT?
FOR PARKINSON S DISEASE XADAGO can increase your daily on time without troublesome dyskinesia 1 Please see the complete Important Safety Information on pages 12-13 and the accompanying full Prescribing
More informationParkinson s Disease WHERE HAVE WE BEEN, WHERE ARE WE HEADING? CHARLECE HUGHES D.O.
Parkinson s Disease WHERE HAVE WE BEEN, WHERE ARE WE HEADING? CHARLECE HUGHES D.O. Parkinson s Epidemiology AFFECTS 1% OF POPULATION OVER 65 MEAN AGE OF ONSET 65 MEN:WOMEN 1.5:1 IDIOPATHIC:HEREDITARY 90:10
More informationSafinamide: un farmaco innovativo con un duplice meccanismo d azione
Safinamide: un farmaco innovativo con un duplice meccanismo d azione AINAT Sardegna Cagliari, 26 novembre 2016 Carlo Cattaneo Corporate Medical Advisor CNS & Rare Diseases Reichmann H. et al., European
More informationEvaluations & CE. With Support From. Featured Speaker 1/20/2016. Conflict of Interest & Disclosure Statements
With Support From University at Albany School of Public Health New York State Department of Health New York State Association of County Health Officials (NYSACHO) Parkinson s Disease: The Importance of
More informationIII./3.1. Movement disorders with akinetic rigid symptoms
III./3.1. Movement disorders with akinetic rigid symptoms III./3.1.1. Parkinson s disease Parkinson s disease (PD) is the second most common neurodegenerative disorder worldwide after Alzheimer s disease.
More informationEuropean Commission approves ONGENTYS (opicapone) a novel treatment for Parkinson s disease patients with motor fluctuations
July 6, 2016 European Commission approves ONGENTYS (opicapone) a novel treatment for Parkinson s disease patients with motor fluctuations Porto, 5 July 2016 BIAL announced that the medicinal product ONGENTYS
More informationCOMMISSIONING POLICY RECOMMENDATION TREATMENT ADVISORY GROUP Policy agreed by (Vale of York CCG/date)
COMMISSIONING POLICY RECOMMENDATION TREATMENT ADVISORY GROUP Policy agreed by (Vale of York CCG/date) Drug, Treatment, Device name Co-careldopa 2000mg/500mg intestinal gel (Duodopa, Solvay Pharmaceuticals)
More informationMovement Disorders: A Brief Overview
Movement Disorders: A Brief Overview Albert Hung, MD, PhD Massachusetts General Hospital Harvard Medical School August 17, 2006 Cardinal Features of Parkinsonism Tremor Rigidity Bradykinesia Postural imbalance
More informationPARKINSON S DISEASE. Nigrostriatal Dopaminergic Neurons 5/11/16 CARDINAL FEATURES OF PARKINSON S DISEASE. Parkinson s disease
5/11/16 PARKINSON S DISEASE Parkinson s disease Prevalence increases with age (starts 40s60s) Seen in all ethnic groups, M:F about 1.5:1 Second most common neurodegenerative disease Genetics role greater
More informationEarly Pharmacologic Treatment in Parkinson s Disease
n report n Early Pharmacologic Treatment in Parkinson s Disease Robert A. Hauser, MD, MBA Abstract Early treatment of Parkinson s disease (PD) affords an opportunity to forestall clinical progression.
More informationPD ExpertBriefings: Parkinson s Medications: Today and Tomorrow Led By: Cynthia L. Comella, M.D., F.A.A.N.
PD ExpertBriefings: Parkinson s Medications: Today and Tomorrow Led By: Cynthia L. Comella, M.D., F.A.A.N. To hear the session live on: Tuesday, April 17, 2012 at 1:00 PM ET. DIAL: 1 (888) 272-8710 and
More informationUpdate on Parkinson s disease and other Movement Disorders October 2018
Update on Parkinson s disease and other Movement Disorders October 2018 DR. JONATHAN EVANS CONSULTANT IN NEUROLOGY QUEEN S MEDICAL CENTRE NOTTINGHAM Disclosures: Honoraria UCB, Britannia, Allergan, AbbVie
More informationContinuous dopaminergic stimulation
Continuous dopaminergic stimulation Angelo Antonini Milan, Italy GPSRC CNS 172 173 0709 RTG 1 As PD progresses patient mobility becomes increasingly dependent on bioavailability of peripheral levodopa
More informationWhat s new for diagnosing and treating Parkinson s Disease?
What s new for diagnosing and treating Parkinson s Disease? Erika Driver-Dunckley, MD Associate Professor of Neurology Program Director Movement Disorders Fellowship Assistant Program Director Neurology
More informationThe symptoms of the Parkinson s disease may vary from person to person. The symptoms might include the following:
1 PARKINSON S DISEASE Parkinson's disease is a long term disease related to the central nervous system that mainly affects the motor system, resulting in the loss of dopamine, which helps in producing
More informationHistory Parkinson`s disease. Parkinson's disease was first formally described in 1817 by a London physician named James Parkinson
Parkinsonismm History Parkinson`s disease Parkinson's disease was first formally described in 1817 by a London physician named James Parkinson Definition : Parkinsonism: Parkinsonism is a progressive neurological
More informationParkinson s Disease. Patients will ask you. 8/14/2015. Objectives
Parkinson s Disease Jean Van Kingsley MS, FNP-BC Objectives Describe the pathophysiolgy of PD. Review clinical charachteristics of PD. Identify management strategies, to maximize functional status. Recognize
More informationParkinson s Disease Initial Clinical and Diagnostic Evaluation. J. Timothy Greenamyre, MD, PhD
Parkinson s Disease Initial Clinical and Diagnostic Evaluation J. Timothy Greenamyre, MD, PhD Involuntary tremulous motion, with lessened muscular power, in parts not in action and even when supported
More informationParkinson Disease. Lorraine Kalia, MD, PhD, FRCPC. Presented by: Ontario s Geriatric Steering Committee
Parkinson Disease Lorraine Kalia, MD, PhD, FRCPC Key Learnings Parkinson Disease (L. Kalia) Key Learnings Parkinson disease is the most common but not the only cause of parkinsonism Parkinson disease is
More informationParkinson s Disease Update. Colleen Peach, RN, MSN, FNP Movement Disorders Clinic Emory University School of Medicine March 7, 2015
Parkinson s Disease Update Colleen Peach, RN, MSN, FNP Movement Disorders Clinic Emory University School of Medicine March 7, 2015 Parkinson s Disease Progressive, chronic, neurodegenerative disease Slow,
More informationKeywords: deep brain stimulation; subthalamic nucleus, subjective visual vertical, adverse reaction
Re: Cost effectiveness of rasagiline and pramipexole as treatment strategies in early Parkinson's disease in the UK setting: an economic Markov model evaluation Norbert Kovacs 1*, Jozsef Janszky 1, Ferenc
More informationParkinson s disease. Quick reference guide. Issue date: June Diagnosis and management in primary and secondary care
Quick reference guide Issue date: June 2006 Parkinson s disease Diagnosis and management in primary and secondary care Developed by the National Collaborating Centre for Chronic Conditions Contents Contents
More informationParkinson s Disease. Gillian Sare
Parkinson s Disease Gillian Sare Outline Reminder about PD Parkinson s disease in the inpatient Surgical patients with PD Patients who cannot swallow End of life care Parkinson s disease PD is the second
More informationLet s Look at Parkinson s (PD) Sheena Morgan Parkinson s Disease Nurse Specialist Isle of Wight NHS Trust November 2016
Let s Look at Parkinson s (PD) Sheena Morgan Parkinson s Disease Nurse Specialist Isle of Wight NHS Trust November 2016 What is Parkinson s? Parkinson's is a progressive neurological condition. People
More informationSuffolk PCT Drug & Therapeutics Committee New Medicine Report (Adopted by the CCG until review and futher notice)
Suffolk PCT Drug & Therapeutics Committee New Medicine Report (Adopted by the CCG until review and futher notice) This drug has been reviewed because it is a product that may be prescribed in primary care.
More informationTreatment Strategies and Quality-of-Care Indicators for Patients With Parkinson s Disease
Treatment Strategies and Quality-of-Care Indicators for Patients With Parkinson s Disease Jack J. Chen, PharmD, BCPS, CGP, FASCP Mark F. Lew, MD Andrew Siderowf, MD, MSCE Supplement April 2009 Vol. 15,
More informationCommonly encountered medications and their side effects - what the generalist needs to know
Commonly encountered medications and their side effects - what the generalist needs to know Jeremy Cosgrove Consultant Neurologist Leeds Teaching Hospitals NHS Trust Outline: Parkinson s medications and
More informationScottish Medicines Consortium
Scottish Medicines Consortium rotigotine 2mg/24 hours, 4mg/24 hours, 6mg/24 hours, 8mg/24 hours transdermal patch (Neupro ) (No: 289/06) Schwarz Pharma Ltd. 7 July 2006 The Scottish Medicines Consortium
More informationMedications used to treat Parkinson s disease
Medications used to treat Parkinson s disease Edwin B. George, M.D., Ph.D. Director of Wayne State University Movement Disorder Clinic University Health Center Neurology Clinic University Health The John
More informationCh. 4: Movement Disorders
Ch. 4: Movement Disorders Hiral Shah, MD Parkinson s Disease and DOPA Cotzias GC, Van Woert MH, and Schiffer, LM. Aromatic Amino Acids and Modification of Parkinsonism. N Engl J Med 1967; 276: 374-379.
More informationCorporate Medical Policy
Corporate Medical Policy Dopamine Transporter Imaging with Single Photon Emission File Name: Origination: Last CAP Review: Next CAP Review: Last Review: dopamine_transporter_imaging_with_single_photon_emission_computed_tomography
More informationMAXIMIZING FUNCTION IN PARKINSON S DISEASE
1 MAXIMIZING FUNCTION IN PARKINSON S DISEASE September 13, 2016 End Falls This Falls Conference Jan Goldstein Elman One Step Ahead Mobility Toronto, Ontario Outline An overview of Parkinson s disease (PD):
More informationCommunicating About OFF Episodes With Your Doctor
Communicating About OFF Episodes With Your Doctor Early in Parkinson s disease (PD), treatment with levodopa and other anti-pd drugs provides continuous benefit. As the disease progresses, however, symptom
More informationUnderstanding Parkinson s Disease Important information for you and your loved ones
Patient Education Understanding Parkinson s Disease Important information for you and your loved ones This handout explains the signs, symptoms, and possible treatments of Parkinson s disease. Parkinson
More informationAlison Charleston 1 st September 2016
Alison Charleston 1 st September 2016 Clinical features of Parkinson s disease Differential diagnosis Management of the motor features Non-motor and neuropsychiatric aspects 100-200 per 100,000 prevalence
More informationKEY SUMMARY. Mirapexin /Sifrol (pramipexole): What it is and how it works. What is Mirapexin /Sifrol (pramipexole)?
KEY SUMMARY 1. Mirapexin /Sifrol (pramipexole*) is a selective non-ergot dopamine agonist approved as immediate release since 1997 for the treatment of the signs and symptoms of idiopathic Parkinson's
More informationIs Safinamide Effective as an Add-on Medication in Treating Parkinson's Disease Motor Symptoms?
Philadelphia College of Osteopathic Medicine DigitalCommons@PCOM PCOM Physician Assistant Studies Student Scholarship Student Dissertations, Theses and Papers 2016 Is Safinamide Effective as an Add-on
More informationCE on SUNDAY Newark, NJ October 18, 2009
CE on SUNDAY Newark, NJ October 18, 2009 Date: Sunday, October 18, 2009 Time: 10:30 AM 11:45 AM Location: Sheraton Newark Airport Hotel Title: Speaker(s): Treating Parkinson s Disease: A Pharmacist s Overview
More informationFaculty Information 2/15/2013
Timothy Reilly, PharmD, BCPS, CGP, FASCP Clinical Assistant Professor Ernest Mario School of Pharmacy Rutgers, The State University of New Jersey tjreilly@pharmacy.rutgers.edu Faculty Information Presenter:
More informationKey Concepts and Issues in Parkinson s Disease in 2016
Key Concepts and Issues in Parkinson s Disease in 2016 Michael Rezak, M.D., Ph.D. Section Chief, Neurosciences Institute Director, Movement Disorders and Neurodegenerative Diseases Center Northwestern
More informationASSFN Clinical Case: Bilateral STN DBS Implant for Parkinson s Disease
ASSFN Clinical Case: Bilateral STN DBS Implant for Parkinson s Disease Parkinson s Disease Cardinal Signs: Resting tremor Rigidity Bradykinesia Postural instability Other Symptoms Dystonia Dysphagia Autonomic
More informationClinical Features and Treatment of Parkinson s Disease
Clinical Features and Treatment of Parkinson s Disease Richard Camicioli, MD, FRCPC Cognitive and Movement Disorders Department of Medicine University of Alberta 1 Objectives To review the diagnosis and
More informationRotigotine patches (Neupro) in early Parkinson s disease Edited by AdRes Health Economics & Outcomes Research
Rotigotine patches (Neupro) in early Parkinson s disease Edited by AdRes Health Economics & Outcomes Research Synthetic DRUG PROFILE Introduction Parkinson s disease (PD) is a neurodegenerative disorder
More informationNew Medicines Committee Briefing July 2011
New Medicines Committee Briefing July 2011 Pramipexole immediate-release (Mirapexin ) and Pramipexole modifiedrelease (Mirapexin prolonged release) for the treatment of Parkinson s Disease Pramipexole
More informationXADAGO (safinamide) oral tablet
XADAGO (safinamide) oral tablet Coverage for services, procedures, medical devices and drugs are dependent upon benefit eligibility as outlined in the member's specific benefit plan. This Pharmacy Coverage
More informationIssues for Patient Discussion
onmotor complications radykinesia Screening Tools asked PD micrographia eurodegeneration Designed for Use by Family Practitioners remor on-off opamine agonists tiffness depression ostural instability wearing
More informationDrugs used in Parkinsonism
Drugs used in Parkinsonism قادة فريق علم األدوية : لي التميمي & عبدالرحمن ذكري الشكر موصول ألعضاء الفريق املتميزين : جومانة القحطاني ندى الصومالي روان سعد القحطاني pharma436@outlook.com @pharma436 Your
More informationTHIS IS NOT YOUR GRANDMOTHER S DISEASE: WHAT DOES BEING DIAGNOSED WITH PARKINSON S DISEASE MEAN TODAY?
THIS IS NOT YOUR GRANDMOTHER S DISEASE: WHAT DOES BEING DIAGNOSED WITH PARKINSON S DISEASE MEAN TODAY? THURSDAY MARCH 14, 2019 REBECCA GILBERT, MD, PHD VICE PRESIDENT, CHIEF SCIENTIFIC OFFICER, APDA AMERICAN
More information