Monitoring of Mobility of Parkinson's Patients for Therapeutic Purposes - Clinical Trial (MoMoPa-EC)

When Parkinson Disease is mild, it responds well to treatment with drugs (L-Dopa and dopamine antagonists). However, as the disease progresses, the effect of the drugs diminishes and lasts for a shorter time (wearing-off), which require physicians to progressively increase and/or break up the dosage of dopamine drugs, to control symptoms over the course of the entire day. Despite this, most patients present motor fluctuations after 10 years. These fluctuations consist of changes between what are known as Off periods, when the medication does not produce an effect and mobility is hindered, and On periods when patients can move smoothly, with the medication producing its best effect. The timeline of these motor fluctuations over the course of the day and also on different days is very valuable to precisely adjust the medication. Nevertheless, neurologists do not currently have detailed information on the timeline of the symptoms of their patients, which means that they have serious difficulties to obtain good results with the adjustment of medication. Currently, the neurologist's information on the time progression of the motor fluctuations is drawn from what the patient indicates in the office visit, or in the best case, from diaries that the patient fills out at home, periodically (e.g. every hour) noting the motor state (On or Off). Although the latter method is still the gold standard in research and in care, it has serious limitations, because patients often forget to record the information (especially when they are in Off), many do not recognize their motor states well, and few can maintain adherence to such a laborious system for more than a few days. The Parkinson Holter (STAT-ON ®) is a wearable device, which objectively measures and records the motor fluctuations of the patients. It does not require intervention by the patient, and can, therefore, be used in daily life, long term if necessary. However, the concept that detailed knowledge of motor fluctuations of patients will lead to better control of the disease, thanks to optimisation of the therapeutic regimen, is still a hypothesis. To demonstrate or refute this hypothesis, we are now conducting a clinical trial, with this medical device, to study the clinical effectiveness in patients with moderate Parkinson's disease and motor fluctuations. This trial will show whether using the Parkinson Holter is better than the clinical interview used in traditional clinical practice (primary objective), and whether it is not inferior to the On-Off diary recorded by the patients at home (exploratory objective)

The neurologists in the study will receive information from the Parkinson Holter (device being studied)

The neurologists in the study will receive no additional information other than what is obtained during the visit

The neurologists will receive the wearable report (for medication adjustment, if any as per physician's criteria/judgement)

The neurologists will receive the patient's diary report (for medication adjustment, if any as per physician's criteria/judgement).

The neurologists will receive the patient & caregiver report at the time of the visit (for medication adjustment, if any as per physician's criteria/judgement).

Changes from baseline to last visit in motor complications, assessed by means of Unified Parkinson's Disease Rating Scale - part IV

Changes from baseline to last visit in the number and severity of freezing of gait episodes, assessed by means of Freezing of Gait Questionnaire

Changes from baseline to last visit in quality of life, assessed by menas of Parkinson's Disease Questionnaire-39

Changes from baseline to last visit in dependence for Activities of Daily Living assessed by means of Unified Parkinson's Disease Rating Scale - part II

Physician and patient satisfaction with the Parkinson Holter will be assessed by means of the Quebec User Evaluation of Satisfaction with assistive Technology (QUEST)

Inclusion Criteria: Ideopathic Parkinson's Disease Disease in the moderate-severe phase (Hoehn & Yahr ≥ 2 en Off) Motor fluctuations (with at least 2h/day in Off) Agree to participate voluntarily and will sign a written consent form Exclusion Criteria: Incapable of walking independently or H&Y=5 Participating in another clinical trial Patients with acute intercurrent disease Psychiatric or cognitive disorders that prevent collaboration (MMSE <24)

Perez-Lopez C, Hernandez-Vara J, Caballol N, Bayes A, Buongiorno M, Lopez-Ariztegui N, Gironell A, Lopez-Sanchez J, Martinez-Castrillo JC, Sauco M A, Lopez-Manzanares L, Escalante-Arroyo S, Perez-Martinez DA, Rodriguez-Molinero A; MoMoPa-EC Research Group. Comparison of the Results of a Parkinson's Holter Monitor With Patient Diaries, in Real Conditions of Use: A Sub-analysis of the MoMoPa-EC Clinical Trial. Front Neurol. 2022 May 16;13:835249. doi: 10.3389/fneur.2022.835249. eCollection 2022.

Rodriguez-Molinero A, Hernandez-Vara J, Minarro A, Perez-Lopez C, Bayes-Rusinol A, Martinez-Castrillo JC, Perez-Martinez DA; Monitoring Parkinson's patients Mobility for therapeutic purposes research group. Multicentre, randomised, single-blind, parallel group trial to compare the effectiveness of a Holter for Parkinson's symptoms against other clinical monitoring methods: study protocol. BMJ Open. 2021 Jul 19;11(7):e045272. doi: 10.1136/bmjopen-2020-045272.