madman
Super Moderator
ABSTRACT:
Objective: To update evidence-based medicine recommendations for treating nonmotor symptoms in Parkinson’s disease (PD). Background: The International Parkinson and Movement Disorder Society Evidence-Based Medicine Committee’s recommendations for treatments of PD were first published in 2002, updated in 2011, and now updated again through December 31, 2016.
Methods: Level I studies testing pharmacological, surgical, or nonpharmacological interventions for the treatment of nonmotor symptoms in PD were reviewed. Criteria for inclusion and quality scoring were as previously reported. The disorders covered were a range of neuropsychiatric symptoms, autonomic dysfunction, disorders of sleep and wakefulness, pain, fatigue, impaired olfaction, and ophthalmologic dysfunction. Clinical efficacy, implications for clinical practice, and safety conclusions are reported.
Results: A total of 37 new studies qualified for review. There were no randomized controlled trials that met inclusion criteria for the treatment of anxiety disorders, rapid eye movement sleep behavior disorder, excessive sweating, impaired olfaction, or ophthalmologic dysfunction. We identified clinically useful or possibly useful interventions for the treatment of depression, apathy, impulse control and related disorders, dementia, psychosis, insomnia, daytime sleepiness, drooling, orthostatic hypotension, gastrointestinal dysfunction, urinary dysfunction, erectile dysfunction, fatigue, and pain. There were no clinically useful interventions identified to treat non-dementia-level cognitive impairment.
Conclusions: The evidence base for treating a range of nonmotor symptoms in PD has grown substantially in recent years. However, treatment options overall remain limited given the high prevalence and adverse impact of these disorders, so the development and testing of new treatments for nonmotor symptoms in PD remains a top priority.
In summary, although RCTs in PD have increasingly involved NMS since the previous update of the MDS EBM review, many nonmotor areas still lack an adequate evidence base of high-quality studies. The MDS is committed to an ongoing process of updating EBM reviews and to making them current and useful to clinicians. Systematic reviews have become a cornerstone of evidence-based healthcare, but approximately half are out of date after 5 years. In addition, the methodology that has been standard for years has limitations (eg, with respect to the lack of strict definitions for implications for clinical practice). Therefore, the MDS is considering changes in methodology, including new assessment tools for grading the evidence, as well as more frequent updates to provide clinicians and investigators with an up-to-date evidence base for their treatment decision-making.
Objective: To update evidence-based medicine recommendations for treating nonmotor symptoms in Parkinson’s disease (PD). Background: The International Parkinson and Movement Disorder Society Evidence-Based Medicine Committee’s recommendations for treatments of PD were first published in 2002, updated in 2011, and now updated again through December 31, 2016.
Methods: Level I studies testing pharmacological, surgical, or nonpharmacological interventions for the treatment of nonmotor symptoms in PD were reviewed. Criteria for inclusion and quality scoring were as previously reported. The disorders covered were a range of neuropsychiatric symptoms, autonomic dysfunction, disorders of sleep and wakefulness, pain, fatigue, impaired olfaction, and ophthalmologic dysfunction. Clinical efficacy, implications for clinical practice, and safety conclusions are reported.
Results: A total of 37 new studies qualified for review. There were no randomized controlled trials that met inclusion criteria for the treatment of anxiety disorders, rapid eye movement sleep behavior disorder, excessive sweating, impaired olfaction, or ophthalmologic dysfunction. We identified clinically useful or possibly useful interventions for the treatment of depression, apathy, impulse control and related disorders, dementia, psychosis, insomnia, daytime sleepiness, drooling, orthostatic hypotension, gastrointestinal dysfunction, urinary dysfunction, erectile dysfunction, fatigue, and pain. There were no clinically useful interventions identified to treat non-dementia-level cognitive impairment.
Conclusions: The evidence base for treating a range of nonmotor symptoms in PD has grown substantially in recent years. However, treatment options overall remain limited given the high prevalence and adverse impact of these disorders, so the development and testing of new treatments for nonmotor symptoms in PD remains a top priority.
In summary, although RCTs in PD have increasingly involved NMS since the previous update of the MDS EBM review, many nonmotor areas still lack an adequate evidence base of high-quality studies. The MDS is committed to an ongoing process of updating EBM reviews and to making them current and useful to clinicians. Systematic reviews have become a cornerstone of evidence-based healthcare, but approximately half are out of date after 5 years. In addition, the methodology that has been standard for years has limitations (eg, with respect to the lack of strict definitions for implications for clinical practice). Therefore, the MDS is considering changes in methodology, including new assessment tools for grading the evidence, as well as more frequent updates to provide clinicians and investigators with an up-to-date evidence base for their treatment decision-making.
