Commentary
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Michael Soileau, MD, FAAN, talked about a panel of specialists who discussed the evolution and multidisciplinary treatment of Parkinson disease, emphasizing patient-centered care and advanced therapeutic options.
Michael Soileau, MD, FAAN
(Credit: LinkedIn)
Parkinson disease (PD) is a common neurodegenerative disorder marked by movement difficulties such as bradykinesia, resting tremor, rigidity, and postural instability. In recent years, newer, safer therapies have begun to emerge that manage symptoms more effectively while also aiming to slow disease progression. These innovative approaches encompass drug repurposing, gene therapies, cell-based treatments, and advanced neurosurgical techniques like refined deep brain stimulation, all of which have the potential to significantly transform PD treatment in the near future.1
Recently, at the 3rd Annual Advanced Therapeutics in Movement and Related Disorders (ATMRD) Congress, held by the PMD Alliance from June 22-25, 2024, Michael Soileau, MD, FAAN, participated in a panel discussion focused on evolving care for PD beyond levodopa treatment. The panel, which included Cheryl Kyinn, PA-C; Fiona Gupta, MD; and Sherrie Gould, MSN, NP-C, covered progress made in treatment for PD and the multidisciplinary strategies for engaging patients and care partners in the changing care landscape.
Following the expert panel discussion, Soileau, a movement disorder specialist at Texas Movement Disorder Specialists, sat down with NeurologyLive® in an interview at the Congress to further discuss how treatment strategies for PD evolved over time. Soileau, who also serves as a clinical assistant professor of medical education at Texas A&M Health Science Center, talked about the challenges faced by healthcare providers in treating PD. Furthermore, he spoke about how a multidisciplinary approach benefits patients with PD based on the conversations that were held during the panel discussion and audience participation.
We had a wonderful panel discussion with 2 advanced practice providers (APPs) and 2 movement disorder specialists, like a fireside chat. It was great. We began by talking about the history of carbidopa/levodopa, when it was first discovered and how it evolved with time. We talked briefly about a broad level of different formulations of the medicine and some strategies of how we work together as a team, with APPs, in a multidisciplinary fashion to treat PD. We talked a bit about motor symptoms, non-motor symptoms, and some treatments there at a broad level.
It was a very comprehensive talk yet with a defined time and some Q&A, which was good from the audience. The audience was made up of movement disorder doctors and providers, but also tons of APPs and general neurologists. We even had a patient who was there this morning. There was a variety of different learners that were interested in what we were talking about.
I would say the first thing is that we have advanced as a field in movement disorders. Gone are the days of the algorithmic, “I want to delay taking dopamine as long as possible so that I don't get motor complications of that, such as dyskinesia or wearing off.” We now understand much more about the pathophysiology of PD and of levodopa, for example. Strategy really matters, essentially. We want everyone to know: we treat the patient, we don't treat to an algorithm. As we look at patients, we need to examine them and see what their motor disability is, see what their non motor symptoms are. The blessing and curse are that we have medicines to do that and good ways to treat patients.
I think the other take home point from the talk was that how we do that matters. I think we're up to 8 or 9 different formulations of levodopa at this point. A lot of people didn't realize that it's such a robust spectrum of levodopa that we have in our toolbox. Each patient's unique, we talked a bit about that with some audience questions. There were good questions asked about, “I have this patient with these symptoms, what's your first step?” We talked about that a bit.
There's a saying “when you see one patient with PD, you've seen only one patient with PD,” because they're all unique. It’s about trying to find that perfect recipe and perfect blend of medicine in order to help treat their symptoms. From the panel, we shared different opinions about things. You had an APPs point of view, you had movement disorder specialist point of view, and so we were trying to just emphasize the need for multidisciplinary care for these patients.
Well, the first one was a healthcare provider that's also a patient with PD. That person had more of a comment than a question and said, “thank you for doing all of this and for going into detail and trying to teach and further the education,” because they didn't know that. I think that's number one, patients are always willing to listen. They're always open to learning new things. One thing that was voiced was the frustration that we all have as healthcare providers, whether it we’re movement disorder specialists or APPs, but there's increasing administrative burden. While we do have all these treatments, it takes a lot of hard work behind the scenes. It’s a lot of paperwork trying to get these treatments approved for our patients, and that's hard.
That's hard to do, but we recognize that we see the fruit at the end of that labor, and so we know there are good medicines. My point to that one person was “thank you for recognizing that but also when they see us in clinic, a lot of times, we want them to leave knowing that this is not as good as it gets.” We have treatment options for them, we just have to be very strategic about what we do, when we do it, and how we do it. That was the very first comment that we had, and it's hard to follow after that. It was someone who's a patient who appreciates that. I mean, what else can you say? That's why we're doing it. So that was wonderful.
The other questions stemmed around strategy on how to treat PD. Do you start with this particular medicine first, or this version of levodopa first? Do you start with others? What happens when patients start to have the ups and downs and the motor fluctuations? What do we do at that point? What are some strategies there? That's what we summarized in our talk.
If anything, from what I’ve seen as a super subspecialist in my community, we are not nearly as aggressive as we could be with treatment for PD. Yes, it involves a lot of work. Yes, it takes a village to do all this. At the same time, the big thing is that we have these treatment options, and we should utilize them. There are a lot of patients that we see that have gone years and years not getting aggressive treatment, and they have lost quality of life during that time. They have suffered needlessly. If we know what's out there, we know how to use it, and we know how to approach treatment when it gets to PD, it's a good thing.
The fact that we have a whole conference surrounding that, not just with PD but all movement disorders, is really good. This is not geared necessarily toward movement disorder specialists, it's geared towards anyone who's curious. Our audience makeup here, that I've seen so far, is multifaceted. There are social workers, nurse practitioners, and APPs. There are general neurologists, movement disorder specialists, you name it. Everyone's hearing the same message. I love that ATMRD is in its third year and love this conference. It's very good, and it's getting bigger and bigger each year. I love that more and more people are hearing about that.
The other thing I'll say is there's a very robust poster session with late breaking research here. I love that we're seeing a lot of up-and-coming therapies that are on display with the posters and the data results that's on display here for all to see. I'm glad that we have that too.
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