Supervised versus unsupervised technology-based levodopa monitoring in Parkinson's disease: an intrasubject comparison.
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Abstract
We aimed to assess the intrasubject reproducibility of a technology based levodopa LD therapeutic monitoring protocol administered in supervised versus unsupervised conditions in patients with Parkinson s disease PD The study design was pilot intrasubject single center open and prospective Twenty patients were recruited Patients performed a standardized monitoring protocol instrumented by an ad hoc embedded platform after their usual first morning LD dose in two different randomized ambulatory sessions one under a physician s supervision the other self administered The protocol is made up of serial motor and non motor tests including alternate finger tapping Timed Up and Go test and measurement of blood pressure Primary motor outcomes included comparisons of intrasubject LD subacute motor response patterns over the 3 h test in the two experimental conditions Secondary outcomes were the number of intrasession serial test repetitions due to technical or handling errors and patients satisfaction with the unsupervised LD monitoring protocol Intrasubject LD motor response patterns were concordant between the two study sessions in all patients but one Platform handling problems averaged 4 of total planned serial tests for both sessions Ninety five percent of patients were satisfied with the self administered LD monitoring protocol To our knowledge this study is the first to explore the potential of unsupervised technology based objective motor and non motor tasks to monitor subacute LD dosing effects in PD patients The results are promising for future telemedicine applications