A new pathway for Parkinson’s disease has been published for the first time to help clinicians treating people who need non-oral medication.
The new guideline pathway provides a road-map for the use of non-oral therapy (apomorphine, intestinal levodopa gel infusion (Duodopa) and deep brain stimulation, and enables physicians to understand referral criteria and the local process for referral.
Developed with the guidance of a steering group of movement disorder specialists, clinicians from the UK Parkinson’s Excellence Network and neurological services commissioners, the framework can be tailored for any area.
Professor Ray Chaudhuri, Kings College Hospital, London, clinical director at International Parkinson’s Centre of Excellence, said the pathway was developed because non-oral therapies have become more important in treating Parkinson’s.
“We now know, as appreciated by James Parkinson himself, that the gut is dysfunctional in Parkinson’s right from the start of the motor disease,” he said.
“There is dysphagia and dribbling of saliva, right from the start of the motor disease in some patients. Continuing oral therapy here puts the patient at risk of aspiration pneumonia a common cause of morbidity in Parkinson’s.
“Then there is a major issue with delayed gastric absorption due to delayed emptying. This has now been clearly linked to phenomena such as early morning off, delayed on, and dose failures. Oral therapy in this situation may be ineffective.
“Add to this small intestinal bacterial overgrowth, constipation as well as bowel transit problems. Non-oral therapies avoid this route and should form an essential part of the therapeutic strategy in Parkinson’s.”
Dr Neil Archibald, consultant neurologist at James Cook University Hospital, Middlesbrough, said the new detailed pathway was long overdue.
“For too long we’ve been using, or trying to use, these treatments in a rather haphazard fashion,” he said.
This guidance is for people with Parkinson’s for whom oral treatments are not working and it will be checked annually for updates.
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