3rd Annual Parkinson’s Disease (PD) Expert Series Meeting

The 3rd Annual PD-Expert Series Meeting took place from 23-24 November 2012 in London, UK. Over 150 delegates representing Consultant Neurologists and Elderly Care physicians, PD nurse specialists, GPs, specialist registrars (SpRs), physiotherapists and pharmacists, attended the conference at the Hilton Tower Bridge Hotel, located in the Borough district of London.

The meeting was chaired by Dr Nin Bajaj, Clinical Director of the National Parkinson Foundation International Centre of Excellence and Honorary Associate Professor in Neurology, University of Nottingham. The meeting was sponsored by UCB Pharma Ltd and 9 CPD points from the RCP was awarded to attendees. A wide range of topics, faculty debates and video case presentations, in conjunction with a ‘real time analysis’ audience voting system used for the first time in this meeting, provided an educational and engaging conference.

Professor Günther Deuschl, President of the International Movement Disorder Society, Christian-Albrechts-University in Kiel, Germany opened the start of the conference with a lecture on current topics in PD. He presented data on the EARLY-STIM study advocating the use of deep brain stimulation (DBS), which is currently a widely accepted practice in the treatment of advanced PD, to be considered in patients with early or moderate PD. The conference then proceeded with a lecture on the non-motor symptoms of PD, with a focus on pain and sleep, given by Professor K Ray Chaudhuri, Clinical Director of the National Parkinson Foundation International Centre of Excellence, Kings College, London. Citing several papers currently in-press, Professor Chaudhuri commented on the importance of healthcare workers asking patients about pain, especially during fluctuations OFF medications, as well as using a new PD pain score undergoing a multi-centre validation study to help investigators monitor pain. The second half of the lecture concentrated on various sleep disorders commonly seen in PD as well as excessive daytime somnolence, a non-motor symptom that often progresses with the disease.

The next two hours were spent with a dynamic interactive video session where a variety of classic and challenging movement disorder cases were presented by various neurology SpRs from all over the country. For the first time, an audience response system was used to provide an amiable but competitive challenge where each table had to compete for points against the meeting’s faculty members. The cases included a diagnosis of aqueductal stenosis potentially causing parkinsonism, episodic ataxia type 2, progressive apraxia of speech, XXYY syndrome, PSP with chorea and finally acquired alien limb syndrome. The faculty was successfully able to defend their honour by a six point lead in this year’s round of questions.

A review on the imaging of motor and non-motor aspects of PD was given by Professor David J Brooks, Hartnett Professor of Neurology and Head of the Centre for Neuroscience, Imperial College, London. He mentioned the correlation between specialised scans (DAT, VMAT2 and DDC) reflecting the severity of disease. He also discussed the use of imaging in recognising the neuroanatomical connections of various motor and non-motor symptoms of PD, such as tremor, dementia, dyskinesia.

Dr Doug MacMahon, Consultant at University Hospitals of Coventry and Warwick NHS Trust presented some of the preliminary results of PD MED, a large multi-centre trial that is evaluating the cost-effectiveness of currently available treatment in early and late PD. After presentation of the preliminary data, many of the audience felt that level of impact in their own practice would be minimal, but the effect of these results on PCTs remains uncertain for the future.

Day one closed after a lively debate on the reliance of clinical acumen solely versus requirement of imaging to confirm the diagnosis of PD. Dr Richard Genever, Movement Disorder Lead, Chesterfield Royal Hospital argued for the former against his opponent, Dr Nin Bajaj. The winner of the debate was Dr Genever, convincing 57% of the audience to rely on clinical acumen solely for diagnosis.

The end of the day was followed by a scrumptious dinner and a lively speech on the future of general neurology by Dr John Paul Leach, Consultant Neurologist, Southern General Hospital, Glasgow.

At the dinner proceeds from the registration fees for the meeting were donated to Parkinson’s UK and Cure Parkinsons by Mr Taco Van Tiel from UCB Pharma and Dr Nin Bajaj.

Saturday morning started out with the second debate, ‘Drug Therapy in Parkinson’s Disease should be given soon after diagnosis and titrated to symptom control.’ Dr Paul Worth, Consultant Neurologist, Norfolk and Norwich University Hospital, argued to not delay treatment, citing that PD was a progressive disease and the goal should be to maintain the best quality of life for as long as possible. His opponent, Dr Romi Saha, Consultant Neurologist, Royal Sussex County Hospital, Brighton, argued against starting early and aggressive treatment, stating that there was no evidence for neuroprotection and there was a benefit of giving patients the time to understand, accept and educate themselves about the diagnosis prior to starting treatment. The final vote was close with 54% agreeing with Dr Worth’s stance.

The second lecture was a very practical and useful topic on functional movement disorders by Dr Mark Edwards, Consultant Neurologist, The Sobell Department of Motor Neuroscience Foundation and Movement Disorders Institute of Neurology, London. Dr Edwards’s talk went through several ‘tricks of the trade’ in evaluating functional patients in various diseases, medico-legal pitfalls and the paucity of available treatments. His lecture was followed by Dr Helen Roberts, Chair of the BGS Movement Disorders Section, Senior Lecturer and Honorary Consultant, University of Southampton on recognising key problems and treatments in Parkinsonism in the older patient.

The final two lectures of the conference gave an overview of PRoBaND (Parkinson’s Repository of Biosamples and Networked Datasets), a large multi-centre biomarker study to prospectively observe patients diagnosed with PD. The primary investigator, Dr Donald Grosset, Consultant Neurologist, Institute of Neurological Sciences, Southern General Hospital, Glasgow discussed the recruitment criteria, the study endpoints and data collection methods as well as the possible applications and collaborations of the study. This was followed by the final lecture by Dr Bajaj on MRI studies looking at neuromelanin and the possibilities of 7T MRI in the evaluation of PD in collaboration with the PRoBaND study.

Overall, the conference was educational and interactive, and met with positive feedback from the multi-disciplinary audience. The controversial topics on the evaluation and treatment of PD and other movement disorders, as well as information on future studies, showcased the current challenges of matching clinical needs with further basic science work in order to provide well-balanced and individualised patient care. The 2013 meeting is certainly one to keep on the calendar for next year.