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Title: Non-motor symptoms in advanced Parkinson's : the natural history and response to advanced therapies
Author: Reddy, Papari Prashanth
ISNI:       0000 0004 5372 0714
Awarding Body: King's College London
Current Institution: King's College London (University of London)
Date of Award: 2015
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Background and Method Non-motor symptoms (NMS) are a key determinant of health related quality of life (HrQoL) in Parkinson’s disease (PD) (Martinez-Martin et al., 2011) and are present in virtually every PD patient. Many aspects of NMS are treatable by dopaminergic drugs (Chaudhuri and Schapira, 2009) and treating NMS remains a key unmet need. (Chaudhuri et al., 2011) Currently treatment choices in advanced PD are Apomorphine (Apo), intra-jejunal levodopa infusion (IJLI) and Deep brain stimulation of the subthalamic nucleus (DBS-STN) and are solely recommended based on motor symptoms. This thesis addresses a range of comparative multicentre, international collaborative studies of real life dopaminergic therapies in PD with a focus on non-motor effects. Non-motor effect has been measured using the validated PD non-motor symptoms scale (NMSS). (Chaudhuri et al., 2007) The largest real life worldwide study with a long-term longitudinal follow-up design addresses a key unmet need with over 40 patients in each arm. Using regression analysis and comparative measures, effects on motor function, quality of life were compared and contrasted with non-motor effects. A patient reported outcome tool was developed using the same cohort of patients. Results and Conclusion This project has shown the beneficial effects of Apo, IJLI and DBS-STN therapies on aspects of NMS in advanced Parkinson’s that translate to a robust improvement in the HrQoL. For the first time we show that there are differences between Apo, a dopamine agonist based therapy versus IJLI (a levodopa therapy) on aspects of NMS and this would need to be explored further. The effects could be explained by a central dopaminergic effect and effective treatment of NMS arising from non-motor fluctuations. (Storch et al., 2013) Choice of advanced therapies in PD should therefore take into account their non-motor effects and patient expectations along with improvement of motor symptoms.
Supervisor: Ray Chaudhuri, Kallol ; Jackson, Stephen Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available