Validation of an electronic motor diary for patients with Parkinson's disease

ALEX MEDINA ESCOBAR; DANIEL CERQUETTI; FEDERICO NANNI; MALCO ROSSI; MARCELO MERELLO

Berlin

Congreso; 20th International Congress of Parkinson?s Disease and Movement Disorders; 2016

Background: The complexity of motor complications in Parkinson´s disease (PD) makes record diaries of duration of ON time, OFF time and severity of dyskinesias a determinant instrument for medication adjustment or evaluation for invasive therapies. ON-OFF paper diaries are widely used; however, adherence, duplication, failed and fraudulent registry entries are frequent. Besides, data post processing and evaluation is time consuming.Objective: To determine the reliability and compliance to electronic motor diary in patients with PD.Methods: We designed an electronic touch screen application with motor state (ON-OFF), dyskinesias and medication alarms with adjustable intervals and medication dose settings to prevent retrospectively data entry. A prospective validation phase of the electronic motor diary was conducted in a movement disorders Clinic during a training and evaluation session in which an acute levodopa challenge was conducted in the OFF medication state to 17 PD patients with motor complications and normal cognition. Motor function was rated by a movement disorders specialist in the basal OFF motor state and repeatedly every 30 minutes. Rater marked patient´s motor state as ON, OFF and registered the presence of dyskinesias. Simultaneously, patients were asked to rate their motor states and the presence or absence of dyskinesias in the electronic device every 30 minutes until they entered to the next OFF state.Results: Thirteen patients were male (76%). The mean age was 59±9.6 years, mean disease duration was 12±5.3 years, mean MDS-UPDRS-III OFF score was 31.8±15.1. Patient´s entries in the electronic diary matched 100% in the basal OFF state and the following three entries during the ON state to rater´s motor state evaluation. In the final entry (while beginning again the OFF state) it matched in 94% of the cases due to inability of some patients to correctly recognize entering again to the OFF state. When dyskinesias were rated as non-troublesome, matching was observed in 88% of entries, while troublesome dyskinesias matched in 100% of entries. A positive feedback was received by the patients about the design and data input method of the electronic device. Conclusions: This electronic motor diary showed to be reliable for ON-OFF states and dyskinesias identification. Electronic motor diaries are ancillary innovative methods for the clinical evaluation of motor complications and medication compliance. A further phase in patient?s home-setting is ongoing to replicate this findings and medication dose settings evaluation.