The BritMoDis meeting in Birmingham offered the opportunity for BGSMDS, BRING-MD and PDNSA the chance to come together for a shared conference for the first time. 110 neurologists, geriatricians, PD nurse specialists and the odd physiotherapist, psychiatrist and rehabilitation consultant met at the Holiday
Inn. The diversity of the delegates was reflected by a varied programme ranging from updates on the latest PD trials to discussions on better multidisciplinary working.
Proceedings commenced with a lively video session facilitated by Kailash Bhatia. The mixture of rare and unusual cases also triggered discussions on imaging in movement disorder clinics and whether a normal FP-CIT scan is actually normal. It also served as a reminder to geriatricians that increased use of video-recording in movement disorder clinics can be an incredibly valuable teaching tool.
Debate – Drug treatment for Parkinson’s disease should be commenced immediately on diagnosis
In the battle of the Profs, Richard Walker and Carl Clarke pitched arguments for and against the motion. Prof Walker brought evidence from ELLDOPA, DATATOP, TEMPO and ADAGIO to support early treatment, while Prof Clarke raised the profile of side-effects and provided closer analysis of the combined results of TEMPO and ADAGIO. The motion was not carried.
Debate - Monitoring test are useful in clinic to follow the progress of Parkinson’s disease.
The case for was given by recently crowned PD Nurse of the year, Tracey Smith who illustrated the benefits of monitoring tools, not only to
demonstrate changes in the patient’s condition but also as a lever to develop services. Helen Roberts gave the argument against and drew attention to the huge number of different tools available, each with different levels of validity in PD, all of which are likely to be dispensed with in favour of clinical experience. Once again, but by a closer margin, the motion was not carried.
Prescribing trends in Parkinson’s disease: Interactive case studies.
Malcolm Steiger charismatically led a session, working through 8 clinical scenarios. While there were no ‘right’ answers it was interesting to note that as the cases became more complex, the levels of agreement reduced. There was little difference between the answers coming from neurologists, geriatricians and PDNSs when each group answered one particular scenario separately.
Graeme Macphee facilitated the post-lunch session. Delegates were divided into groups on roughly geographical grounds and worked through a case to explore ideas around PD at each of the 4 stages of the paradigm. Themes that developed included defining the roles of the MDT, strategies for managing cognitive problems in PD, dealing with peri-operative complications of Parkinson’s and when to introduce the concept of palliation.
New and Ongoing Research in Movement Disorders
David Burn: The PROMS-PD study is looking at depressive disorders in PD. The 1st patient was recruited in 2007 and it is going to run for 5 years. It hopes to identify different affective phenotypes in Parkinson’s, risk factors for developing these symptoms and their impact on outcomes.
MUSTARDD-PD is a randomised double-blind trial of donepezil vs placebo in Parkinson’s. It is hoped that site initiation will begin later this year.
Adrian Williams: PD-SURG has shown that DBS is an effective treatment in the UK. The magnitude of benefit was smaller than has been seen in some DBS studies but it looked at a population where apomorphine was an available option.
Carl Clarke: 1620 early disease and more than 500 later stage patients were recruited to PD-MED, which assessed the effects of levodopa vs dopamine agonists vs MAOB-Is. The follow-up period ends in 2011.
PD-REHAB randomises its participants to receive OT and physiotherapy intervention or not in early disease. The recruitment process began in January 2010.
PD-COMM has just reached the submission stage. It will compare the effects of LSVT vs standard NHS Speech and Language Therapy vs ‘attention control’.
Huw Morris: WTCCC2-PD (Wellcome Trust Case Control Consortium) which is still in progress is hoped to give a greater understanding of the pathways leading to the development of Parkinson’s disease and the different subtypes of the condition.
Brit MODIS hopes to have a conference every two years.
Thanks go to The Turner Agency for organising the event and to all the sponsors for their support.