Videos

2 experts are featured in this series.

Panelists discuss how treatment options for advanced Parkinson disease patients like the 54-year-old woman include deep brain stimulation (DBS) as an excellent choice given her young age and cognitive status, with amantadine delayed-release/extended-release showing robust effects comparable to DBS (about 3 hours of increased good ON time) in patients meeting DBS criteria, while newer infusion therapies may offer potential benefits through both pharmacokinetic effects from reducing peak-trough levels and a theoretical "deep priming" process that could reset hypersensitive dopamine receptors by providing continuous stimulation, though more research data is needed to confirm these hypothetical benefits.

2 experts are featured in this series.

Panelists discuss how delayed-release/extended-release amantadine represents a unique treatment option for patients like the 54-year-old woman with both dyskinesia and “off” time, as it is the only FDA-approved medication that addresses both conditions simultaneously, with its bedtime dosing and pharmacokinetic profile providing overnight absorption and sustained daytime levels that resulted in phase 3 trials showing a 40% reduction in dyskinesia and 2.4 hours of increased good “on” time, making it an ideal first-line treatment for patients who have both troublesome dyskinesia and motor fluctuations rather than simply reducing dopaminergic medications which would worsen motor symptoms.

2 experts are featured in this series.

Panelists discuss how a 54-year-old woman with early-onset Parkinson disease presenting with troublesome peak-dose dyskinesia affecting her work performance illustrates the challenge of managing patients who have both dyskinesia and likely OFF episodes, requiring careful assessment of functional impacts through targeted questioning about daily activities, work performance, and social interactions, since patients often minimize or remain unaware of their dyskinesia's true impact while caregivers may provide crucial insights into how the involuntary movements affect not only the patient but also family dynamics and professional relationships.

2 experts are featured in this series.

Panelists discuss how dyskinesia affects 30% to 50% of Parkinson patients by 5 years and over 90% by 10 years, creating significant functional limitations including impaired writing, eating, and dressing abilities, increased fall risk, job performance challenges, social isolation due to embarrassment about abnormal movements, and restrictions on therapeutic options since increasing levodopa doses to manage OFF time would worsen dyskinesia, ultimately impacting both patients' basic human dignity and their caregivers' quality of life.

A panelist discusses the use of dual orexin receptor antagonists as a first-line treatment for chronic insomnia due to their efficacy in improving sleep without the risks of dependence or cognitive issues, while also noting their effectiveness in patients with psychophysiologic insomnia and the importance of managing patient expectations regarding their use.