Beyond Motor Symptom Wearing-off in Parkinson’s Disease – What Are We Missing?

In the treatment of Parkinson’s disease (PD), wearing-off refers to the recurrence of motor (and non-motor) symptoms typically preceding scheduled doses of anti-parkinsonian medication. These can exert a substantial functional burden on the patient, are a frequent occurrence in patients with PD, can occur early in the disease, and most individual symptoms are progressive. As such, efforts should be made to detect wearing-off as early as possible so that appropriate therapeutic action can be taken to mitigate symptoms. Here we present the highlights of a satellite symposium held at the 2019 International Congress of Parkinson’s Disease and Movement Disorders, Nice, France, discussing the clinical spectrum of wearing-off symptoms, including both motor and non-motor features, the challenges clinicians face in the management of wearing-off, our current understanding regarding the time course of motor fluctuations and how this has evolved beyond the classical view of PD staging, and available treatments to mitigate both motor and non-motor symptoms.

#Parkinson’s disease, wearing-off, motor symptoms, non-motor symptoms

Olivier Rascol has served as a consultant or on advisory boards for AbbVie, Adamas, Acorda Therapeutics, Addex, AlzProtect, Apopharma, AstraZeneca, Bial, Biogen, Britannia, Bukwang Pharmaceutical Co., Ltd, Clevexel, Denali Therapeutics, INC Reasearch, Lundbeck, Lupin, Merck, MundiPharma, Neuratris, NeuroDerm, Novartis, ONO Pharma, Osmotica, Oxford Biomedica, Parexel, Pfizer, Prexton Therapeutics, Quintiles, Sanofi, Servier, Sunovion, Theranexus, Takeda, Teva, UCB, Vectura, Watermark Research, XenoPort, XO and Zambon; has received grants from the French National Research Agency (ANR), University Hospital Centre of Toulouse, France Parkinson, INSERM-DHOS Translational Clinical Research, Michael J Fox Foundation, Hospital Clinical Research Program and the European Commission (Horizon 2020, 7th Framework Programme); and an honorarium to participate in a symposium and contribute to the review of an article for the International Parkinson and Movement Disorder Society. Hubert Fernandez has acted as a consultant for Acorda Therapeutics, Amneal, Bial Neurology, CNS Ratings LLC, Denali Therapeutics, Kyowa Hakko Kirin, Pfizer, Partners Healthcare System/Parkinson Study Group, Revance Therapeutics, Sun Pharmaceutical Industries, Sunovion Research and Development Trust; as an independent contractor (including contracted research) for Acorda Therapeutics, Michael J Fox Foundation, Movement Disorders Society, National Institute of Health’s National Institute of Neurological Disorders and Stroke, Parkinson Study Group, Sunovion, Elsevier as the Editor in Chief of Parkinsonism & Related Disorders; and has been involved in teaching and speaking activities for the American Osteopathic Association, Bial, Cleveland Clinic, South Alabama Medical Science Foundation, Thoraxx Clinical Communications and Ultimate Medical Academy Education. Per Odin has received honoraria for consultancies, advisory boards and speaker activities from AbbVie, Britannia, Lundbeck, Nordic Infucare, Teva, UCB, Zambon and Bial; and has participated as an investigator in clinical studies performed by AbbVie and Britannia. Joaquim Ferreira has received payments for consultancy, advisory boards and grants from Abbott, AbbVie, Affiris, Allergan, Bial, Biogen, Fundação MSD (Portugal), GlaxoSmithKline, Grunenthal, Ipsen, Lundbeck, Medtronic, Merck Serono, Merz, MSD, Novartis, Solvay, Sunovion Pharmaceuticals, Teva and Zambon.

This article reports the proceedings of a sponsored satellite symposium and did not involve any studies with human or animal subjects performed by any of the authors.

Medical writing support was provided by Stuart Wakelin and Alex Lowe of Touch Medical Communications and funded by Bial

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