Place of Continuous Subcutaneous Infusion Systems in Parkinson Disease Management

Author(s):

Stuart H. Isaacson, MD, FAAN,Daniel E. Kremens, MD, JD

Panelists discuss how continuous subcutaneous infusion systems should be strategically positioned within Parkinson disease management, typically as options for patients with advanced disease experiencing motor fluctuations despite optimized oral therapy.

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

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

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Placement of Infusion Therapies in Parkinson Disease Management

Consider after oral medication optimization fails to provide adequate control
Position before deep brain stimulation (DBS) in treatment algorithm
Appropriate for patients with medication-responsive symptoms but problematic motor fluctuations
Viable option when cognitive/psychiatric issues contraindicate DBS
Can be used as a transitional therapy before considering more invasive options
Particularly valuable for patients with unpredictable off periods
May be considered earlier in disease course than traditionally recommended for advanced therapies
Best implemented with a multidisciplinary team approach (neurology, nursing, pharmacy)
Should be part of a comprehensive care plan addressing motor and nonmotor symptoms