Papers by Dr. Michael Lorrain
Epidemiological aspects of Parkinson's disease (PD), co-occurring diseases and medical healthcare... more Epidemiological aspects of Parkinson's disease (PD), co-occurring diseases and medical healthcare utilization of PD patients are still largely elusive. Based on claims data of 3.7 million statutory insurance members in Germany in 2015 the prevalence and incidence of PD was determined. PD cases had at least one main hospital discharge diagnosis of PD, or one physician diagnosis confirmed by a subsequent or independent diagnosis or by PD medication in 2015. Prevalence of (co-)occurring diseases, mortality, and healthcare measures in PD cases and matched controls were compared. In 2015, 21,714 prevalent PD cases (standardized prevalence: 511.4/100,000 persons) and 3,541 incident PD cases (standardized incidence: 84.1/100,000 persons) were identified. Prevalence of several (co-)occurring diseases/complications, e.g., dementia (PD/controls: 39/13%), depression (45/22%), bladder dysfunction (46/22%), and diabetes (35/31%), as well as mortality (10.7/5.8%) differed between PD cases and controls. The annual healthcare utilization was increased in PD cases compared to controls, e.g., regarding mean ± SD physician contacts (15.2 ± 7.6/12.2 ± 7.3), hospitalizations (1.3 ± 1.8/0.7 ± 1.4), drug prescriptions (overall: 37.7 ± 24.2/21.7 ± 19.6; anti-PD medication: 7.4 ± 7.4/0.1 ± 0.7), assistive/therapeutic devices (47/30%), and therapeutic remedies (57/16%). The standardized prevalence and incidence of PD in Germany as well as mortality in PD may be substantially higher than reported previously. While frequently diagnosed with co-occurring diseases/complications, such as dementia, depression, bladder dysfunction and diabetes, the degree of healthcare utilization shows Parkinson's Disease Epidemiology and Healthcare in Germany large variability between PD patients. These findings encourage a rethinking of the epidemiology and healthcare utilization in PD, at least in Germany. Longitudinal studies of insurance claims data should further investigate the individual and epidemiological progression and healthcare demands in PD.
Journal of Neural Transmission, Mar 24, 2017
Advanced stages of Parkinson's disease (advPD) still impose a challenge in terms of classificatio... more Advanced stages of Parkinson's disease (advPD) still impose a challenge in terms of classification and related stage-adapted treatment recommendations. Previous concepts that define advPD by certain milestones of motor disability apparently fall short in addressing the increasingly recognized complexity of motor and non-motor symptoms and do not allow to account for the clinical heterogeneity that require more personalized approaches. Therefore, deep phenotyping approaches are required to characterize the broad-scaled, continuous and multidimensional spectrum of disease-related motor and non-motor symptoms and their progression under real-life conditions. This will also facilitate the reasoning for clinical care and therapeutic decisions, as neurologists currently have to refer to clinical trials that provide guidance on a group level; however, this does not always account for the individual needs of patients. Here, we provide an overview on different classifications for advPD that translate into critical phenotypic patterns requiring the differential therapeutic adjustments. New concepts refer to precision medicine approaches also in PD and first studies on genetic stratification for therapeutic outcomes provide a potential for more objective treatment recommendations. We define novel treatment targets that align with this concept and make use of emerging device-based assessments of real-life information on PD symptoms. As these approaches require empowerment of patients and integration into treatment decisions, we present communication strategies and decision support based on new technologies to adjust treatment of advPD according to patient demands and safety.
Journal of Neural Transmission, Jul 3, 2015
During the last decades, symptomatic treatment of motor symptoms of Parkinson&amp... more During the last decades, symptomatic treatment of motor symptoms of Parkinson's disease (PD) improved continuously and is reflected by long-range independency of the patient during the disease course. However, advanced stages of PD still represent an important challenge to patients, caregivers and treating physicians. In patients with advanced PD, interventional therapy strategies are increasingly applied. These device-related treatment strategies using pump-based continuous dopaminergic stimulation (CDS) or deep brain stimulation (DBS) opened new treatment options especially if motor complications predominate. Well-designed clinical studies on these interventional therapeutic approaches provided class 1 evidence for the efficacy of DBS and CDS in advanced PD and opened new perspectives for their use in earlier disease stages also. Therefore, careful selection of patients amenable to the (semi)invasive therapy options becomes more and more important and requires an interdisciplinary setting that accounts for (i) optimal patient information and awareness, (ii) selection of best individual treatment modality, (iii) training of relatives and caregivers, (iv) management of complications, and (v) follow-up care. Here, we address these topics by summarizing current state-of-the-art in patient selection, providing specificities of treatment options and troubleshooting, and defining steps towards an optimized patient-centered care. Interventional therapies pioneer in the area of individualized treatment approaches for PD, and may be complemented in the future by biomarker-based improved stratification and by closed-loop systems for adaptive therapeutic strategies. In the present review, we summarize the proceedings of an Expert Workshop on Parkinson's disease held on November 22, 2014 in Frankfurt, Germany.
Frontiers in Neurology, Jun 29, 2018
Epidemiological aspects of Parkinson's disease (PD), co-occurring diseases and medical healthcare... more Epidemiological aspects of Parkinson's disease (PD), co-occurring diseases and medical healthcare utilization of PD patients are still largely elusive. Based on claims data of 3.7 million statutory insurance members in Germany in 2015 the prevalence and incidence of PD was determined. PD cases had at least one main hospital discharge diagnosis of PD, or one physician diagnosis confirmed by a subsequent or independent diagnosis or by PD medication in 2015. Prevalence of (co-)occurring diseases, mortality, and healthcare measures in PD cases and matched controls were compared. In 2015, 21,714 prevalent PD cases (standardized prevalence: 511.4/100,000 persons) and 3,541 incident PD cases (standardized incidence: 84.1/100,000 persons) were identified. Prevalence of several (co-)occurring diseases/complications, e.g., dementia (PD/controls: 39/13%), depression (45/22%), bladder dysfunction (46/22%), and diabetes (35/31%), as well as mortality (10.7/5.8%) differed between PD cases and controls. The annual healthcare utilization was increased in PD cases compared to controls, e.g., regarding mean ± SD physician contacts (15.2 ± 7.6/12.2 ± 7.3), hospitalizations (1.3 ± 1.8/0.7 ± 1.4), drug prescriptions (overall: 37.7 ± 24.2/21.7 ± 19.6; anti-PD medication: 7.4 ± 7.4/0.1 ± 0.7), assistive/therapeutic devices (47/30%), and therapeutic remedies (57/16%). The standardized prevalence and incidence of PD in Germany as well as mortality in PD may be substantially higher than reported previously. While frequently diagnosed with co-occurring diseases/complications, such as dementia, depression, bladder dysfunction and diabetes, the degree of healthcare utilization shows Parkinson's Disease Epidemiology and Healthcare in Germany large variability between PD patients. These findings encourage a rethinking of the epidemiology and healthcare utilization in PD, at least in Germany. Longitudinal studies of insurance claims data should further investigate the individual and epidemiological progression and healthcare demands in PD.
Aktuelle Neurologie, Dec 1, 2007
At the end of 2005 with the support of the German Parkinson's Association (dPV), 17 000 patie... more At the end of 2005 with the support of the German Parkinson's Association (dPV), 17 000 patients with Parkinson's disease were provided with a questionnaire about various aspects of Parkinson's disease and, above all, about the therapy . A total of 6 500 questionnaires were available for evaluation. The results of this evaluation show that 80 % of the Parkinson's patients experience restrictions in their daily activities. More than every second patient suffers from morning stiffness and 57 % from sleep disturbances. The transdermal administration or Rotigotin and the thus assured continuous supply of the drug could be associated with advantages both from the view point of the physician and from that of the patient.
Clinical Nutrition, Aug 1, 2003
Rationale: Aim: to demonstrate that infants fed exclusively during 4 weeks with the new SED grow ... more Rationale: Aim: to demonstrate that infants fed exclusively during 4 weeks with the new SED grow according to Eurogrowth references, and to assess the amino acid and fatty acid profiles. Method: Methods: prospective study; the SED (extensive whey hydrolysate; 3.0 g protein, 5.2 g fat and 10.7 g cxbohy&ates per 100 Kcal) was given exclusively during 4 weeks to 34 infants. Results: Results: 9/34 infants hopped out. In total, 533 liters of "New Alfan?' were consumed during 775 days. No serious adverse event happened. Indications for the SED were: NEC, short bowel, feed intolerance, failure to thrive, protein allergy. On average, the infants (age 3 -65 weeks) received 85.8 + 26.8 kcal/kg body weight/day (range 35-137) or 122.5 + 38.3 ml/kg (range 50 -196). After 4 weeks of full enteral feeding with the SED, the BMI-for-age Z-score increases significantly (p:O.O2), from -0.91 + 2.00 to -0.42 + 1.81. The weight-for-age Z score was -1.14 + 1.96 at inclusion and -1.19 + 1.84 after one month. Thus, the weight-for-age Z-score did not change during the one month intervention. The length-for-age Z-score was 0.73 + 1.42 at entry and -1.27 + 1.51 after 1 month. The concentration of albumin increased significantly. The concentration of aspartate, glutamine, glycine, serine and threonine decreases significantly, whereas hyptophane, isoleucine, leucine, phenylalanine, valine and tyrosine tend to increase (p:O.O7). Linolic, linoleic acid, short and medium chain fatty acid levels did not change. The concentration of C20:3n6, C20:5n3 (EPA), and C22:4n6 increased. The average number of stools was 2.12 + 1.21, and stools were considered "hard" in 9% and liquid in 26%. The number per day of cramps (if there were cmmps) is on average 1.98f0.97, of spitting (if present) is 2.28f1.21 and for vomiting (if present) is 1.47f0.72. Conclusions: Conclusion. The "New Alfxe" is well tolerated, and some nutritional parameters tend to improve.
Fortschritte Der Neurologie Psychiatrie, Jun 1, 2017
Journal of Clinical Medicine, 2020
Access to specialized care is essential for people with Parkinson´s disease (PD). Given the growi... more Access to specialized care is essential for people with Parkinson´s disease (PD). Given the growing number of people with PD and the lack of general practitioners and neurologists, particularly in rural areas in Germany, specialized PD staff (PDS), such as PD nurse specialists and Parkinson Assistants (PASS), will play an increasingly important role in the care of people with PD over the coming years. PDS have several tasks, such as having a role as an educator or adviser for other health professionals or an advocate for people with PD to represent and justify their needs. PD nurse specialists have been established for a long time in the Netherlands, England, the USA, and Scandinavia. In contrast, in Germany, distinct PDS models and projects have been established. However, these projects and models show substantial heterogeneity in terms of access requirements, education, theoretical and practical skills, principal workplace (inpatient vs. outpatient), and reimbursement. This review...
Journal of Clinical Medicine, 2020
Although our understanding of Parkinson’s disease (PD) has improved and effective treatments are ... more Although our understanding of Parkinson’s disease (PD) has improved and effective treatments are available, caring for people with PD remains a challenge. The large heterogeneity in terms of motor symptoms, nonmotor symptoms, and disease progression makes tailored individual therapy and individual timing of treatment necessary. On the other hand, only limited resources are available for a growing number of patients, and the high quality of treatment cannot be guaranteed across the board. At this point, networks can help to make better use of resources and improve care. The working group PD Networks and Integrated Care, part of the German Parkinson Society, is entrusted to convene clinicians, therapists, nurses, researchers, and patients to promote the development of PD networks. This article summarizes the work carried out by the working group PD Networks and Integrated Care in the development of standards of network care for patients with PD in Germany.
Translational Neurodegeneration, 2020
Background The efficacy and safety of opicapone, a once-daily catechol-O-methyltransferase inhibi... more Background The efficacy and safety of opicapone, a once-daily catechol-O-methyltransferase inhibitor, have been established in two large randomized, placebo-controlled, multinational pivotal trials. Still, clinical evidence from routine practice is needed to complement the data from the pivotal trials. Methods OPTIPARK (NCT02847442) was a prospective, open-label, single-arm trial conducted in Germany and the UK under clinical practice conditions. Patients with Parkinson’s disease and motor fluctuations were treated with opicapone 50 mg for 3 (Germany) or 6 (UK) months in addition to their current levodopa and other antiparkinsonian treatments. The primary endpoint was the Clinician’s Global Impression of Change (CGI-C) after 3 months. Secondary assessments included Patient Global Impressions of Change (PGI-C), the Unified Parkinson’s Disease Rating Scale (UPDRS), Parkinson’s Disease Questionnaire (PDQ-8), and the Non-Motor Symptoms Scale (NMSS). Safety assessments included evaluatio...
Frontiers in Neurology, 2018
Epidemiological aspects of Parkinson's disease (PD), co-occurring diseases and medical healthcare... more Epidemiological aspects of Parkinson's disease (PD), co-occurring diseases and medical healthcare utilization of PD patients are still largely elusive. Based on claims data of 3.7 million statutory insurance members in Germany in 2015 the prevalence and incidence of PD was determined. PD cases had at least one main hospital discharge diagnosis of PD, or one physician diagnosis confirmed by a subsequent or independent diagnosis or by PD medication in 2015. Prevalence of (co-)occurring diseases, mortality, and healthcare measures in PD cases and matched controls were compared. In 2015, 21,714 prevalent PD cases (standardized prevalence: 511.4/100,000 persons) and 3,541 incident PD cases (standardized incidence: 84.1/100,000 persons) were identified. Prevalence of several (co-)occurring diseases/complications, e.g., dementia (PD/controls: 39/13%), depression (45/22%), bladder dysfunction (46/22%), and diabetes (35/31%), as well as mortality (10.7/5.8%) differed between PD cases and controls. The annual healthcare utilization was increased in PD cases compared to controls, e.g., regarding mean ± SD physician contacts (15.2 ± 7.6/12.2 ± 7.3), hospitalizations (1.3 ± 1.8/0.7 ± 1.4), drug prescriptions (overall: 37.7 ± 24.2/21.7 ± 19.6; anti-PD medication: 7.4 ± 7.4/0.1 ± 0.7), assistive/therapeutic devices (47/30%), and therapeutic remedies (57/16%). The standardized prevalence and incidence of PD in Germany as well as mortality in PD may be substantially higher than reported previously. While frequently diagnosed with co-occurring diseases/complications, such as dementia, depression, bladder dysfunction and diabetes, the degree of healthcare utilization shows Parkinson's Disease Epidemiology and Healthcare in Germany large variability between PD patients. These findings encourage a rethinking of the epidemiology and healthcare utilization in PD, at least in Germany. Longitudinal studies of insurance claims data should further investigate the individual and epidemiological progression and healthcare demands in PD.
Fortschritte der Neurologie · Psychiatrie, 2017
ZusammenfassungDie ambulante Versorgung von Parkinsonpatienten in Deutschland ist seit Langem eta... more ZusammenfassungDie ambulante Versorgung von Parkinsonpatienten in Deutschland ist seit Langem etabliert. Da die Prävalenz der Parkinsonerkrankung kontinuierlich zunimmt, erhält der ambulante neurologische Sektor eine zunehmende Bedeutung und muss sich aktuellen Erfordernissen anpassen. Dies umfasst eine Optimierung der Versorgungsstrukturen für Parkinsonpatienten sowie adäquate Konzepte für die Durchführung einer (Differenzial-)Diagnostik und Therapie. Viele Patienten werden von nicht spezialisierten neurologischen Facharztpraxen oder auch von Allgemeinmedizinern versorgt, ohne dass ein Austausch mit auf Bewegungsstörungen spezialisierten Neurologen oder spezialisierten universitären Ambulanzen besteht. Ein Bindeglied zwischen diesen Versorgungsstrukturen kann eine Parkinsonschwerpunktpraxis bieten, deren Idee und Konzeption in diesem Artikel vorgestellt werden soll. Neben der Notwendigkeit und dem Nutzen einer solchen Institution sollen auch strukturelle Voraussetzungen und grundle...
Journal of neural transmission (Vienna, Austria : 1996), Jan 24, 2017
Advanced stages of Parkinson's disease (advPD) still impose a challenge in terms of classific... more Advanced stages of Parkinson's disease (advPD) still impose a challenge in terms of classification and related stage-adapted treatment recommendations. Previous concepts that define advPD by certain milestones of motor disability apparently fall short in addressing the increasingly recognized complexity of motor and non-motor symptoms and do not allow to account for the clinical heterogeneity that require more personalized approaches. Therefore, deep phenotyping approaches are required to characterize the broad-scaled, continuous and multidimensional spectrum of disease-related motor and non-motor symptoms and their progression under real-life conditions. This will also facilitate the reasoning for clinical care and therapeutic decisions, as neurologists currently have to refer to clinical trials that provide guidance on a group level; however, this does not always account for the individual needs of patients. Here, we provide an overview on different classifications for advPD t...
Journal of neural transmission (Vienna, Austria : 1996), Jan 3, 2015
During the last decades, symptomatic treatment of motor symptoms of Parkinson's disease (PD) ... more During the last decades, symptomatic treatment of motor symptoms of Parkinson's disease (PD) improved continuously and is reflected by long-range independency of the patient during the disease course. However, advanced stages of PD still represent an important challenge to patients, caregivers and treating physicians. In patients with advanced PD, interventional therapy strategies are increasingly applied. These device-related treatment strategies using pump-based continuous dopaminergic stimulation (CDS) or deep brain stimulation (DBS) opened new treatment options especially if motor complications predominate. Well-designed clinical studies on these interventional therapeutic approaches provided class 1 evidence for the efficacy of DBS and CDS in advanced PD and opened new perspectives for their use in earlier disease stages also. Therefore, careful selection of patients amenable to the (semi)invasive therapy options becomes more and more important and requires an interdiscipli...
Movement Disorders, 2012
Background:A growing number of patients is treated with intrathecal application of autologous bon... more Background:A growing number of patients is treated with intrathecal application of autologous bone marrow cells (aBMCs), but clinical data are completely lacking in movement disorders. We provide first clinical data on efficacy and safety of this highly experimental treatment approach in parkinsonian syndromes.Methods:Retrospective data collection from patients with parkinsonism who spontaneously sought cell treatment. The application procedure was neither recommended nor performed by the authors.Results:We report 17 patients with parkinsonian syndromes (Parkinson's disease [PD], n = 7; multiple system atrophy [MSA], n = 7; various, n = 3) who received intrathecal application of aBMCs. We did not observe any changes in motor function, activities of daily living, global clinical impression, or antiparkinsonian medication after a median observation period of 10 months. Two patients reported a worsening of parkinsonian symptoms, but the intervention was otherwise safe and well‐tole...
Archives of Gerontology and Geriatrics, 2010
Aktuelle Neurologie, 2008
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Papers by Dr. Michael Lorrain