Effect of educational intervention on medication timing in Parkinson's disease: a randomized controlled trial
Background: Medicine usage in Parkinson's disease patients is often imperfect, in particular irregular timing of medication. The effect of informing Parkinson's disease patients about the continuous dopaminergic hypothesis (to encourage regular medicine intake) on medication adherence and motor control was tested. Methods: Patients were randomised either to the active group (receiving the intervention) or control group (no extra information). Antiparkinson medicine usage was monitored for 3 months before and after the intervention using electronic pill bottles which record the date and time of opening (MEMS®, Aardex, Switzerland) and data used to calculate the percentage of doses taken at correct time intervals. Results: 43 patients (52%) were randomised to active counselling, and 40 (48%) were controls (standard management). The intervention effect (difference in timing adherence preto postintervention between the 2 groups) was 13.4% (CI 5.1 to 21.7), p = 0.002. Parkinson motor scores did not change significantly (active group 0.1, CI -3.4 to 3.7) versus controls (4.5, CI 1.6 to 7.1), p = 0.06. Conclusion: Timing adherence, but not motor scores, improves by providing patients with extra information. Therapy timing is of potential importance in Parkinson's disease management. Trial registration number: NCT00361205 Background Patients with Parkinson's disease (PD) depend on medication for relief of motor symptoms, and for this reason are often assumed to medicate very carefully. Overall, medication adherence is very good, but a subset of 15 to 20% of cases take less than 80% of the total prescribed dose[1,2], although the limit of 80% of tablet intake is often applied, this is arbitrary and does not have a strong pharmacological basis[3]. However, irregular timing of drug ingestion is almost universal[2], perhaps contributed by fluctuating symptoms and drug regimen complexity. Pulsatile dopaminergic stimulation in the basal ganglia is implicated in the development and manifestation of motor complications of advancing PD[4]. The mechanism of motor complications is complex but may relate partly to erratic absorption and short half-life of levodopa causing fluctuating serum and brain drug levels and abnormal pulsatile stimulation of striatal dopamine receptors [5,6] contrasting with more continuous neurone firing under normal circumstances [7,8]. In early disease Published: 16 July 2007 BMC Neurology 2007, 7:20 doi:10.1186/1471-2377-7-20 Received: 14 July 2006 Accepted: 16 July 2007 This article is available from: http://www.biomedcentral.com/1471-2377/7/20 © 2007 Grosset and Grosset; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.