Clinical Experience With CSAI for Parkinson Disease

EP: 1.Off Fluctuations in Parkinson Disease

EP: 2.Adjusting and Changing Treatment Regimens in Parkinson Disease

EP: 3.Recognition of Off Episodes in Parkinson Disease

EP: 4.Conversations About Off Time In Patients With Parkinson Disease

EP: 5.Advanced Treatment Options in Parkinson Disease

EP: 6.Adjunctive Treatments and Apomorphine for Treatment of Parkinson Disease

EP: 7.Continuous Subcutaneous Apomorphine Infusion (CSAI) and TOLEDO Study in Parkinson Disease

EP: 8.CSAI and INFUS-ON Study for Treatment of Parkinson Disease

EP: 9.Continuous Subcutaneous Infusion Systems for Parkinson Disease and Patient Selection Criteria

EP: 10.Place of Continuous Subcutaneous Infusion Systems in Parkinson Disease Management

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EP: 11.Clinical Experience With CSAI for Parkinson Disease

EP: 12.Place of Recent Approvals in Parkinson Disease Management

EP: 13.Patient Conversation and Adoption of CSAI in Clinical Practice

EP: 14.Clinical Nurse Educators, Dosing Titrations to Manage Parkinson Disease

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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