Choosing Wisely: five recommendations related to tests, treatments, and procedures at risk of inappropriateness in the cure of Parkinson’s disease (LIMPE-DISMOV Academy)
We are reporting five recommendations related to tests, treatments, and procedures at risk of inappropriateness in the cure of Parkinson’s disease. These recommendations were identified by the Academy for the Study of Parkinson’s Disease and Movement Disorders (LIMPE-DISMOV Academy), in collaboration with Slow Medicine. Slow Medicine, an Italian movement of health professionals, patients, and citizens promoting a “Measured, Respectful and Equitable Medicine”, launched the campaign “Doing more does not mean doing better- Choosing Wisely Italy” in Italy at the end of 2012, similar to Choosing Wisely in the USA. The campaign aims to help physicians, other health professionals, patients, and citizens engage in conversations about tests or procedures commonly used in their field whose necessity should be questioned and discussed. This call to action has resulted in specialty-specific lists of “Things Providers and Patients Should Question.”
Do not use the brain single photon emission tomography with tracers for dopaminergic transporters (DAT-SPECT) for the prognosis and to ascertain the progression of Parkinson’s disease.
Do not use antipsychotic medication except clozapine and quetiapine to treat psychosis in Parkinson’s disease.
Do not delay prescribing Levodopa therapy to treat patients early in the course of Parkinson’s disease.
Do not use myocardial scintigraphy with metaiodobenzylguanidine (MIBG) to diagnose Parkinson’s disease.
Do not use anticholinergic drugs to treat the motor symptoms of drug-induced parkinsonisms.
Although anticholinergic drugs have been widely used in the control of parkinsonian symptoms in Parkinson’s disease and in parkinsonisms (including drug-induced parkinsonism), the current evidence shows that such drugs have a limited benefit on tremor and are associated with cognitive and neuropsychiatric side effects.
Thus, the use of anticholinergics should be limited in patients with comorbidities as cognitive impairment or clinically significant psychiatric illness. Furthermore, the use of anticholinergic drugs is not recommended for the treatment of motor symptoms in drug-induced parkinsonisms .
The mission of Choosing Wisely is to promote conversations between clinicians and patients by helping patients to choose care that is supported by evidence, not duplicative of other tests or procedures already received, free from harm and truly necessary. The LIMPE-DISMOV Academy as national society with the mission of fighting against Parkinson’s disease and of promoting strong interactions between patients and clinicians decided to join with enthusiasm the Choosing Wisely campaign in the hope that the recognition of evidence-based recommendations regarding low-value services in our specialty reduce unnecessary care, avoid harm, and decrease waste.
Future studies will verify if targeting these low-value services and implementing Choosing Wisely recommendations related to tests, treatments, and procedures at risk of inappropriateness in the cure of Parkinson’s disease will achieve the expected positive results.
Collaborators (Board of the LIMPE-DISMOV Academy)
A. Albanese, Department of Neurology, Istituto Clinico Humanitas, Rozzano, Milan, Italy.
A. Antonini, Department of Neurosciences, University of Padua, Padua, Italy.
A. Berardelli, G. Fabbrini, Department of Human Neurosciences, Sapienza, University of Rome and IRCCS Neuromed, Pozzilli, Italy.
C. Colosimo, Department of Neurology, Santa Maria University Hospital, Terni, Italy.
G. Cossu, Department of Neurology, AOB “G. Brotzu” General Hospital, Cagliari, Italy.
G. Defazio, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.
L. Lopiano, Department of Neuroscience “Rita Levi Montalcini,” University of Turin, Turin, Italy.
F. Mancini, Department of Neurology-Stroke Unit and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy.
R. Marconi, Unità Operativa Complessa di Neurologia, Ospedale Misericordia, Grosseto, Italy.
F. Morgante, Department of Experimental and Clinical Medicine, University of Messina, Messina, Italy.
M.T. Pellecchia, Center for Neurodegenerative Diseases (CEMAND), Neuroscience Section, University of Salerno, Salerno, Italy.
M. Zappia, Clinica Neurologica I Policlinico Universitario, Catania, Italy.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
This article does not report data collected by any of the authors from human participants or animals.
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