Device-aided therapies (DAT), such as continuous subcutaneous apomorphine infusion (CSAI), levodopa-carbidopa intestinal gel infusion (LCIG), and deep brain stimulation of the subthalamic nucleus ...(STN-DBS), have markedly changed the treatment landscape of advanced Parkinson's disease (aPD). In some patients, it is necessary to switch or combine DATs for various reasons. The aim of this retrospective study was to explore the frequency and reasons for switching between or combining DATs in two movement disorders centres in Slovenia and Israel.
We collected and analysed demographic and clinical data from aPD patients who switched between or combined DATs. Motor and non-motor reasons, adverse events for switching/combining, and their frequency were examined, as was the effect of DAT using the Global Improvement subscale of the Clinical Global Impression Scale, Movement Disorders Society Unified Parkinson's Disease Rating Scale part III, Mini Mental State Examination, and Parkinson's Disease Questionnaire 39. Descriptive statistics and non-parametric tests were used to analyse the data.
Of 505 aPD patients treated with DATs at both centres between January 2009 and June 2021, we identified in a total of 30 patients (6%) who either switched DAT (
= 24: 7
, 1
, 5
, 8
, 1
, 1
, and 1
) or combined DATs (
= 6:5
and 1
). In most of these patients, an inadequate control of motor symptoms was the main reason for switching or combining DATs, but non-motor reasons (related to the disease and/or DAT) were also identified.
Switching between and combining DATs is uncommon, but in some patients brings substantial clinical improvement and should be considered in those who have either inadequate symptom control on DAT treatment or have developed DAT-related complications.
More than 30 patients with multiple sclerosis (MS) and Parkinson's disease (PD) have been reported so far. Theories on the co-occurrence of MS and PD range from coincidental to causal. There has been ...only one report of MS in young onset PD in a patient heterozygous for Parkin mutation. We report a patient with MS who developed signs typical for PD and was found to be heterozygous mutation carrier in the gene for glucocerebrosidase (GBA1), a well-known risk factor for PD.
•We report a case of MS patient who developed PD and was found to be heterozygous carrier of GBA1 gene mutation.•MS might increase the chances of PD development in GBA1 gene mutation carriers.•The mechanisms by which GBA1 mutations increase the risk of development PD in the setting of MS are not known.
PDF
