Opinion
Video
Clinical Experience With CSAI for Parkinson Disease
Panelists discuss how their clinical experience with continuous subcutaneous infusion therapies has informed their approach to integrating these treatments into existing regimens, including strategies for medication adjustments and valuable lessons from European clinical practice that could benefit US clinicians.
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Clinical Experience With Infusion Systems
Experience with Continuous Subcutaneous Apomorphine Infusion (CSAI) and Other Infusions:
- Learning curve for both clinicians and patients
- Initial intensive monitoring period crucial for success
- Importance of team-based approach to management
- Technical challenges with devices gradually resolved with experience
- Patient selection critically impacts outcomes
Incorporation Into Existing Treatment Plans:
- Gradual introduction alongside existing oral medications
- Individualized titration based on symptom response
- Maintenance of morning oral medication is often beneficial
- Combination with low-dose oral therapy for overnight symptom control
- Careful monitoring during transition period
Adjusting Levodopa and Other Medications:
- Systematic reduction based on observed response to infusion
- Typically, 30% to 50% reduction in oral levodopa dose initially
- Complete elimination of certain adjunctive medications possible
- Individual titration based on symptom diaries and clinical assessment
- Maintaining minimum necessary oral medications to optimize benefit-risk ratio
Lessons From European CSAI Experience:
- Importance of dedicated nursing support for successful implementation
- Need for thorough patient education and expectation management
- Value of standardized protocols for initiation and troubleshooting
- Strategic management of common adverse effects improves adherence
- Multidisciplinary approach improves outcomes and patient satisfaction
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