Summary
Parkinson’s disease (PD) is a chronic, progressive neurodegenerative disorder and the second most common neurodegenerative disease after Alzheimer’s disease in the United States. Approximately 1 million Americans have PD, and the worldwide prevalence among those aged 65 years or older is 1% to 2%. With the aging world’s population, the prevalence of PD is expected to triple within the next 50 years. Through a series of interactive case studies, this educational activity will provide important insights into effective management, including diagnosis and treatment of early idiopathic PD. This educational activity will help you identify patients in need of early treatment and to distinguish disease progression from suboptimal treatment outcomes with the goal of improving patient care.

Goal
To provide the target audience with up-to-date practical information on the treatment and managment of patients with early idiopathic Parkinson's disease.

Target Audience
This activity is designed for neurologists, movement disorder specialists, neuro-geriatric psychiatrists, and other professionals interested in Parkinson's disease (PD) or caring for patients with PD. No prerequisites required.

Learning Objectives
At the conclusion of this activity, the participant should be able to:

  • Identify patients with Parkinson's disease (PD) in need of early treatment.
  • Become familiar with the current treatment algorithms and medical considerations related to perceived degree of disability, individual needs, disease stage, and the age of the patient.
  • Distinguish disease progression from suboptimal treatment of PD.
  • Explain the role of the dopamine pathway in PD.
  • Discuss the pharmacology of dopaminergic drugs.
  • Describe the clinical application of nondopaminergic drugs and the practical advantages that they may offer in the management of PD in clinical practice.
  • Identify the benefits of continuous dopaminergic stimulation in order to improve patient quality of life.

The Johns Hopkins University School of Medicine takes responsibility for the content, quality, and scientific integrity of this CE activity.

CME Information
Accreditation Statement
The Johns Hopkins University School of Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

Credit Designation Statement
The Johns Hopkins University School of Medicine designates this educational activity for a maximum of 2 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

After reading this case module, participants may receive credit by completing the CE test, evaluation, and receiving a score of 70% or higher.

Release date: December 31, 2008. Expiration date: December 31, 2010.

Estimated time to complete activity: 2 hours

Full Disclosure Policy Affecting CME Activities
As a provider accredited by the Accreditation Council for Continuing Medical Education (ACCME), it is the policy of The Johns Hopkins University School of Medicine to require the disclosure of the existence of any relevant financial interest or any other relationship a faculty member or a sponsor has with the manufacturer(s) of any commercial product(s) discussed in an educational presentation. The participating faculty reported the following:

Faculty
Zoltan Mari, MD (Chair)
Assistant Professor
Department of Neurology
Johns Hopkins University
Baltimore, Maryland

Cynthia L. Comella, MD
Professor
Department of Neurological Sciences
Movement Disorders Section
Rush University Medical Center
Chicago, Illinois

Daniel Tarsy, MD
Professor in Neurology
Harvard Medical School
Director, Parkinson’s Disease and Movement Disorders Center
Beth Israel Deaconess Medical Center
Boston, Massachusetts

Leo Verhagen Metman, MD, PhD
Associate Professor
Department of Neurological Sciences
Movement Disorders Section
Rush University Medical Center
Chicago, Illinois

Zoltan Mari, MD, reports having no relevant financial or advisory relationships with corporate organizations related to this activity.

Cynthia L. Comella, MD, reports receiving grants/research support from Allergan Inc, Boehringer Ingelheim, Ipsen Pharma, Merz Pharmaceuticals, and Solvay SA; and serving as a consultant for Boehringer Ingelheim, Impax Laboratories, Inc, Merz Pharmaceuticals, UCB Pharma, and Valeant Pharmaceuticals International.

Daniel Tarsy, MD, reports having no relevant financial or advisory relationships with corporate organizations related to this activity.

Leo Verhagen Metman, MD, PhD, reports receiving grants/research support from Advanced Neuromodulation Systems, Inc., Allergan Inc, Bayer, Boothroyd Foundation, Ceregene, Inc, Merck & Co, Inc, Michael J. Fox Foundation, and National Institutes of Health; serving as a consultant for Impax Laboratories, Inc and Medtronic, Inc; and serving on the speakers’ bureau for UCB Pharma and Vernalis.

Off-Label Product Discussion:
Notice: The audience is advised that an article in this CME activity contains reference(s) to unlabeled or unapproved uses of drugs or devices.

Dr Mari—domperidone.

All other faculty have indicated that they have not referenced unlabeled/unapproved uses of drugs or devices.

Disclaimer Statement
The opinions and recommendations expressed by faculty and other experts whose input is included in this program are their own. This enduring material is produced for educational purposes only. Use of The Johns Hopkins University School of Medicine and The Institute for Johns Hopkins Nursing names implies review of educational format, design, and approach. Please review the complete prescribing information of specific drugs or combinations of drugs, including indications, contraindications, warnings, and adverse effects, before administering pharmacologic therapy to patients.

Internet CME Policy
The Office of Continuing Medical Education (CME) at The Johns Hopkins University School of Medicine is committed to protect the privacy of its members and customers. Johns Hopkins University SOM CME maintains its Internet site as an information resource and service for physicians, other health professionals and the public. Continuing Medical Education at The Johns Hopkins University School of Medicine will keep your personal and credit information confidential when you participate in a CME Internet based program. Your information will never be given to anyone outside of The Johns Hopkins University School of Medicine’s CME program. CME collects only the information necessary to provide you with the services that you request.

Supported by an educational grant from UCB, Inc.
 

Overview

  • 45-year-old woman with initial presentation 2 years ago of heaviness and dexterity problems in the left hand
  • Clumsiness of left hand
  • Cramping and tremor in left leg
  • Sense of imbalance when walking
  • History of depression
 

Overview

  • 55-year-old male with 5-year history of Parkinson's Disease
  • Initial presentation of mild right upper-extremity resting tremor and reduced right arm swing
  • Started on rotigotine 3 years after presentation and titrated to 4 mg daily with improvement in symptoms
  • Rotigotine was discontinued several months later because of manufacturing problems
  • Patient began to have increased bradykinesia, with right hand resting tremor, impaired rapid finger tapping, wrist rotations, and toe tapping on the right with mild right upper extremity rigidity; right arm swing was absent
  • Started on pramipaxole and titrated to 4.5 mg daily
 

Overview

  • 63-year-old relatively healthy white man with 3-year history of Parkinson’s disease.
  • Initial symptoms include left-hand tremor, micrographia, diminished left-arm swing, and shuffling
  • Ropinirole was started and produced great benefit at 1 mg 3 times daily
  • Patient subsequently developed breakthrough tremor, gradually worsening gait disorder, slowing, fatigue, and insomnia
  • Ropinirole titration (to 3 mg 3 times daily) helped symptoms partially
  • Further increase caused excessive daytime somnolence, with sleep attack while driving
  • History of depression, resistant to SSRIs and TCAs; adequate response only to tranylcypromine
 
 
 
     
 
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