The management approaches to dyskinesia vary from country to country.

Many Parkinson's disease (PD) patients treated with levodopa develop motor fluctuations and/or dyskinesia. This large, retrospective study was conducted to compare the prevalence and treatment of dyskinesia in PD patients in seven countries. A total of 380 physicians were interviewed and completed patient record forms retrospectively for their last 5 patients with dyskinesia (total 1,900). The overall prevalence of dyskinesia in PD patients was 34%, but the rate varied from 24 to 51% according to geographical location. This study showed that 51.0% of Japanese physicians and 50.6% of UK physicians were dissatisfied with current treatment strategies for dyskinesia. Regardless of geographical location, physicians were dissatisfied with the current treatment strategies for dyskinesia.

Patient evaluation of a home diary to assess duration and severity of dyskinesia in Parkinson disease.

OBJECTIVE: To evaluate patient perceptions of a new home diary designed to assess the duration and severity of dyskinesia in patients with Parkinson disease (PD) and to investigate whether the use of a training video and pictograms aids patient understanding of PD terminology. METHODS: Fifty advanced PD patients (Hoehn and Yahr stage 2.5-4.0; dyskinesia for >25% of the waking day) from the United States (n = 18), France (n = 12), and Germany (n = 20) were allocated alternately to 1 of 2 groups and shown a training video either with pictograms or without pictograms. The video explained the functional states "asleep," "OFF," "ON without dyskinesia," and "ON with dyskinesia," and how to complete the diary. Patients were given the corresponding version of the diary with or without pictograms to complete over a 24-hour period. Patients then participated in a second interview in which they were shown the alternate version of the video and diary for discussion only. RESULTS: Almost 95% of patients (47/50) reported that the video helped them to understand and clarify terms. Most patients [39/50 (78%)] preferred the diary with pictograms, but there was no evidence that pictograms improved the accuracy of diary completion. Overall, 80% of patients (40/50) completed the diaries correctly. Incorrect diary completion was usually because of confusion about the different functional states. CONCLUSIONS: Patients perceive diaries with pictograms as more helpful than those with words alone. Videos, in the patients' primary language, are considered valuable training aids that help patients complete daily diaries.

A critical review of pharmacoeconomic studies of acamprosate.

AIMS: This review assessed the published data on the cost-effectiveness of acamprosate for the treatment of alcohol dependence. METHODS: Four Markov modelling studies have assessed the therapeutic benefit and economic impact of acamprosate on the treatment of alcohol dependence. These have evaluated both short-term and long-term outcomes and have used German, Belgian, and Spanish costings. A fifth prospective cohort study collected real outcomes and data on expenditure during a 1 year study follow-up period. RESULTS: All five studies have produced consistent results, showing the use of acamprosate, which enhances abstinence rates, to reduce the total costs of treatment and thus be dominant over other rehabilitation strategies not involving pharmacotherapy. In all of the studies, the principal cost-driver is hospitalization. Although there is a short-term increase in treatment costs associated with drug acquisition, these are recovered from long-term savings attributable to reduced hospitalization and rehabilitation costs.