In Parkinson’s disease, one of the most troubling clinical issues for prevention and management is drug-induced dyskinesia. Dyskinesias are abnormal and involuntary movements that relate in part to underlying Parkinson’s disease itself and to drugs used to treat Parkinson’s disease.
Over the last two decades numerous research efforts have focused on understanding the regions of the brain responsible for dyskinesias and the brain chemicals involved. As a result, new treatments, both medical and surgical, have been developed and are currently being tested. In concert, the care of patients and research efforts to understand dyskinesias demand the availability of accurate and easily used clinical rating scales. The ability to measure dyskinesia characteristics over time allows for comparability of treatment outcomes, helps the interpretation of results that are clinically meaningful, and minimizes errors.
This Michael J. Fox Foundation grant will support the final development and testing the Unified Dyskinesia Rating Scale (UDysRS), a composite and adaptation of several pre-existing scales that together assess the key components of dyskinesias. The UDysRS measures the intensity of dyskinesias in different body areas, the degree of impairment caused by dyskinesias when patients perform tasks of daily living, and the patient’s perception of disability from dyskinesias. The scale has been tested in preliminary form in small series of patients and is now ready for larger testing to establish its utility, a process termed, Clinimetric Testing.
The Michael J. Fox Foundation grant, in conjunction with additional funding from Merck KaA/EMD Pharmaceutical, will support the phases of the full Clinimetric Program of the UDysRS: 1) finalization of the UDysRS including the writing of an instruction manual for its use and a filming protocol that can be used internationally; 2) clinimetric testing on the UDysRS to establish that the scale accurately capture the key elements of dyskinesias when it is used in different settings (reliability and validity); 3) Development of a teaching tape to be given to the Movement Disorder Society for training raters for multicenter studies on dyskinesia treatments; 4) manuscript preparation and presentation at an international meeting.
Final Outcome
The UDysRS has been developed, tested and introduced to the neurological community. With MJFF support, a multi-site trial to analyze the responsivity of the scale of dyskinetic treatment began in January 2010. The study will interface with the Movement Disorder Society's efforts to develop official non-English translations in German and French of both the MDS-Unified Parkinson's Disease Rating Scale and the Unified Dyskinesia Rating Scale.