Technology in Parkinson's disease: challenges and opportunities

"The miniaturization, sophistication, proliferation, and accessibility of technologies are enabling the capture of more and previously inaccessible phenomena in Parkinson's disease (PD). However, more information has not translated into a greater understanding of disease complexity to satisfy diagnostic and therapeutic needs. Challenges include noncompatible technology platforms, the need for wide-scale and long-term deployment of sensor technology (among vulnerable elderly patients in particular), and the gap between the “big data” acquired with sensitive measurement technologies and their limited clinical application. Major opportunities could be realized if new technologies are developed as part of open-source and/or open-hardware platforms that enable multichannel data capture sensitive to the broad range of motor and nonmotor problems that characterize PD and are adaptable into self-adjusting, individualized treatment delivery systems. The International Parkinson and Movement Disorders Society Task Force on Technology is entrusted to convene engineers, clinicians, researchers, and patients to promote the development of integrated measurement and closed-loop therapeutic systems with high patient adherence that also serve to (1) encourage the adoption of clinico-pathophysiologic phenotyping and early detection of critical disease milestones, (2) enhance the tailoring of symptomatic therapy, (3) improve subgroup targeting of patients for future testing of disease-modifying treatments, and (4) identify objective biomarkers to improve the longitudinal tracking of impairments in clinical care and research. This article summarizes the work carried out by the task force toward identifying challenges and opportunities in the development of technologies with potential for improving the clinical management and the quality of life of individuals with PD."info:eu-repo/semantics/acceptedVersio

Technology in Parkinson's disease:challenges and opportunities

The miniaturization, sophistication, proliferation, and accessibility of technologies are enabling the capture of more and previously inaccessible phenomena in Parkinson's disease (PD). However, more information has not translated into a greater understanding of disease complexity to satisfy diagnostic and therapeutic needs. Challenges include noncompatible technology platforms, the need for wide-scale and long-term deployment of sensor technology (among vulnerable elderly patients in particular), and the gap between the "big data" acquired with sensitive measurement technologies and their limited clinical application. Major opportunities could be realized if new technologies are developed as part of open-source and/or open-hardware platforms that enable multichannel data capture sensitive to the broad range of motor and nonmotor problems that characterize PD and are adaptable into self-adjusting, individualized treatment delivery systems. The International Parkinson and Movement Disorders Society Task Force on Technology is entrusted to convene engineers, clinicians, researchers, and patients to promote the development of integrated measurement and closed-loop therapeutic systems with high patient adherence that also serve to (1) encourage the adoption of clinico-pathophysiologic phenotyping and early detection of critical disease milestones, (2) enhance the tailoring of symptomatic therapy, (3) improve subgroup targeting of patients for future testing of disease-modifying treatments, and (4) identify objective biomarkers to improve the longitudinal tracking of impairments in clinical care and research. This article summarizes the work carried out by the task force toward identifying challenges and opportunities in the development of technologies with potential for improving the clinical management and the quality of life of individuals with PD. © 2016 International Parkinson and Movement Disorder Society

Thirty Years of Parkinson's Disease Management: From a Symptom-Based Approach to a Holistic Perspective

No neurological disorder other than Parkinson's disease (PD) can boast so many revolutionary events, in its history. The treatment of choice has primarily been the dopamine precursor levodopa. After its introduction, the impact of disease on mortality significantly decreased, yet affected people had to face severe drug-related side effects. Around 40 years ago, other symptomatic drugs, including monoamine oxidase type B (MAO-B) inhibitors and dopamine agonists (DA), used as first-line therapy in de novo patients, were reportedly effective at preventing the levo-Dopa long-term treatment syndrome. Afterwards, catechol-O-methyltransferase inhibitors and long-release DA were added to the toolkit, as a means to obtain a steady control on motor symptoms, but their effectiveness was overtaken, 30 years ago, by functional neurosurgery that ensured brilliant results with the bilateral subthalamic deep brain stimulation (DBS) technique. Notwithstanding such care improvement, people with PD still experienced long-lasting ever-growing disability. Over the last 10 years, evidence on the efficacy of motor training has accumulated, supporting the role of exercise for promoting activity-dependent neuroplasticity, thus opening a new perspective on non-pharmacological disease modifying interventions