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LE TERAPIE COMPLESSE DELLA MALATTIA DI PARKINSON AVANZATA

LE TERAPIE COMPLESSE DELLA MALATTIA DI PARKINSON AVANZATA Il riconoscimento precoce delle complicanze motorie e non motorie nella Malattia di Parkinson Le terapie complesse: criteri di selezione dei pazienti Silvia Ramat MD PhD Responsabile Ambulatorio Parkinson

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LE TERAPIE COMPLESSE DELLA MALATTIA DI PARKINSON AVANZATA

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  1. LE TERAPIE COMPLESSE DELLA MALATTIA DI PARKINSON AVANZATA Il riconoscimento precoce delle complicanze motorie e non motorie nella Malattia di Parkinson Le terapie complesse: criteri di selezione dei pazienti Silvia Ramat MD PhD Responsabile Ambulatorio Parkinson Neurologia 1 AOU Careggi Firenze

  2. Cosa si intende per Malattia di Parkinson in fase avanzata?

  3. Holistic management of Parkinson’s disease, now recognised as a combined motor and nonmotor disorder, remains a key unmet need. • Such management needs relatively accurate definition of the various stages of Parkinson’s from early untreated to late palliative as each stage calls for personalised therapies. • Management also needs to have a robust knowledge of the progression pattern and clinical heterogeneity of the presentation of Parkinson’s which may manifest in a motor dominant or nonmotor dominant manner.

  4. The “advanced” stages of Parkinson’s disease qualify for advanced treatments such as with continuous infusion or stereotactic surgery yet the concept of “advanced Parkinson’s disease” remains controversial in spite of growing knowledge of the natural history of the motor syndrome of PD. • Nonmotor aspects of PD may also reflect advancing course of the disorder, so far not reflected in usual scale based assessments which are largely focused on motor symptoms.

  5. Quale terapia per quale paziente? Motor complications can be disabling for PD patients, and their management is complex and requires experienced assessment to provide the best treatment choice.

  6. Currently available therapies include drug manipulation, infusion, and surgery. New approaches are being investigated, and the number of treatment options is increasing. • In general, the best results are achieved with timely referral to tertiary centers that provide appropriate patient screening and selection and a multidisciplinary approach. • This means that patients should be properly evaluated by a multidisciplinary team of specialists that would ideally include movement disorders neurologists, neurosurgeons, neurophysiologists, psychiatrists, neuropsychologists, nurse practitioners/coordinators, and physical therapists.

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