Electronic Compliance Monitoring in Parkinson's Disease
|Study Design:||Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single Blind
Primary Purpose: Treatment
|Official Title:||Electronic Compliance Monitoring in Parkinson's Disease|
- Timing compliance
- Parkinson motor scores
|Study Start Date:||November 2003|
|Estimated Study Completion Date:||September 2005|
Patients attending a regional movement disorder clinic with idiopathic PD (by UK Brain Bank criteria) and prescribed one or more antiparkinson drug (including dopamine agonist or levodopa) were invited to participate. Patients who were unable to manipulate the electronic pill monitoring bottles, or whose compliance would be adversely affected by using the electronic pill monitoring bottles (e.g. those reliant on a compliance aid) were excluded. The study received ethics approval and signed consent was obtained. During the study medication was adjusted according to clinical need. The increase in levodopa equivalent units during the study period was calculated according to established formula.
Baseline assessments of unified Parkinson’s disease rating scale (UPDRS), Hoehn and Yahr, Schwab and England, mini-mental state examination, geriatric depression scale and quality of life score (PDQ 39) were performed. Clinical scoring was blind to patient group and performed in an ‘on’ state. The UPDRS 3 and adverse events were recorded at each visit. The quality of life score (PDQ 39) was repeated at the final visit.
All antiparkinson drugs were monitored during two 3 month periods (before and after the educational intervention) using electronic monitoring pill bottles (MEMS®, Aardex, Switzerland), a device which records the time and date of bottle opening.
Patients randomly assigned (computer generated and placed in opaque envelopes) to the active (counselled) group were given verbal and written information about the continuous dopaminergic theory, and written advice on optimal medicine timing tailored to their own drug regimen. The counselling explained that in health, brain dopamine is constant, and that fluctuations from Parkinson’s medications should be minimised to simulate normal dopamine levels. Control patients received standard care, but also had medication intake monitored using the MEMS device.
Timing compliance (the percentage of doses taken at the correct time interval) was calculated using time intervals which optimise the pharmacokinetic profile, plus a 25% allowance, eg. 3 times daily medication is satisfactory at between 6 and 10 hours. Selegiline 5mg twice daily was excluded from analysis as the second dose is taken at lunchtime to avoid sleep disturbance.
Please refer to this study by its ClinicalTrials.gov identifier: NCT00361205
|Principal Investigator:||Donald Grosset, MBChB, MD|