Management of Late Stage Parkinson’s Disease:
A Focus on Motor Complications

Janis Miyasaki, MD

Module 1: Motor fluctuations

Module 2: Dyskinesias

Module 3: Surgical considerations in Parkinson’s disease

Introduction

In the following video webcast, Dr. Janis Miyasaki, Associate Clinical Director, The Movement Disorders Centre, Toronto Western Hospital, University Health Network, University of Toronto, provides an overview of the motor complications that occur in the pharmacological management of late stage Parkinson’s disease. She reviews the types of dyskinesias that can occur in later stage disease and their management. She concludes with a discussion of surgical interventions in select patient using deep brain stimulation.

Intended Audience

This continuing medical education program is intended for primary care physicians and other healthcare professionals who manage patients with Parkinson's disease.

Educational Objectives

After completing this activity, participants should be better able to:

List the motor complications in Parkinson’s disease
Discuss the therapeutic threshold
List appropriate medications for “wearing-off” and their common side effects
Describe the dosing and titration schedules for drugs used to treat Parkinson’s disease
Describe the types of drug-induced dyskinesias and the dosage thresholds for dyskinesias
List the patient questions to obtain a history of dyskinesias, and drugs to counteract this adverse effect
List the ideal patient characteristics for DBS, the target motor symptoms of DBS, and possible surgical complications

Information on CME credit

The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

The American Medical Association designates this educational activity for a maximum of 0.5 AMA PRA Category 1 Credit™. Physicians should only claim credit commensurate with the extent of their participation in the activity. Nonphysicians may receive a certificate of participation for completing this activity.

Instructions for CME credit

This online enduring material is presented as a video webcast with attendant slide presentation. To receive credit, please view all of the presentations of this CME activity and evaluate the content presented. Complete both the pre- and post-test and activity evaluation.

The estimated time to complete this activity, including pre-test, review of the materials, and self-assessment and evaluation is 0.5 hour.

Principal Faculty

William J. Weiner, MD, Planning Committee Chair, Content Reviewer
Professor of Neurology
Chair, Department of Neurology
Director, Maryland Parkinson's Disease and Movement Disorder Center
University of Maryland School of Medicine
Baltimore, MD

Janis Miyasaki, MD, MEd, FRCPC, Author and Presenter
Associate Clinical Director
The Movement Disorders Centre
Toronto Western Hospital
University Health Network
University of Toronto
Toronto, Ontario, Canada

Shobha S. Rao, MD, Planning Committee, Content Reviewer
Assistant Professor
Family and Community Medicine
Departments of Geriatric and Family Medicine
University of Texas Southwestern Medical School
Dallas, TX

Kathleen M. Shannon, MD, Planning Committee, Content Reviewer
Associate Professor, Neurological Sciences
Department of Neurology
Rush Movements Disorders Group
Rush-Presbyterian-St. Luke's Medical Center
Rush Medical College
Chicago, IL

Oksana Suchowersky, MD, FRCPC, FCCMG, Planning Committee, Content Reviewer
Professor and Head
Department of Medical Genetics
Director, Movement Disorders Program
University of Calgary
Calgary, AB, Canada

R. Mark Evans, PhD
Director, Healthcare Education Products and Standards
American Medical Association
Chicago, IL

Kristi Eidsvoog, PhD
Content Manager
MedEd Architects, LLC
Chicago, IL

Patti Fitzgerald
Manager, Product Development, Healthcare Education Products and Standards
American Medical Association
Chicago, IL

Disclosure Policy

In order to assure the highest quality of CME programming, and to comply with the ACCME Standards for Commercial Support, the AMA requires that all faculty and planning committee members disclose relevant financial relationships with any commercial or proprietary entity producing health care goods or services relevant to the content being presented. We therefore obtain a completed disclosure and attestation form to inform the participant of any pertinent relationships disclosed, provided here.

These materials have been peer-reviewed by the members of the CME Advisory Board and the AMA Editorial Board to ensure the continued scientific accuracy and medical relevance of information presented and its independence from commercial bias. The AMA has control over all final content.

Dr. Rao: Nothing relevant to disclose

Dr. Shannon: Research Support, Kyowa, Schwarz, Teva, Schering/Titan; Consultant, Valeant, Prestwick

Dr. Suchowersky: Speaker's Bureau, Teva, Novartis; Advisory Board, Teva, Novartis

Dr. Weiner: Advisory Board, Novartis; Research Support, Boehringer-Ingelheim, Teva; Speaker's Bureau, Teva

Dr. Miyasaki: Research support, Boehringer-Ingelheim, Elan, Solvay, and Teva; Consultant, Boehringer-Ingelheim

Dr. Evans: Nothing relevant to disclose

Dr. Eidsvoog: Nothing relevant to disclose

Ms. Fitzgerald: Nothing relevant to disclose

Acknowledgement of Support

This CME publication was supported through an independent education grant from Teva Neuroscience and produced in accordance with the AMA Standards for Industry-Supported Multimedia Continuing Medical Education and Other Communications.