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      The '5 or 2 or 1' criteria may be adopted as a simple screening tool for assessing symptom control2,3

      A Delphi-panel approach was utilised to synthesise opinions from movement disorder specialists and build a consensus on markers for the progression to Complex/Advanced Parkinson's disease (PD). They identified 3 criteria as key indicators of transition to Complex/Advanced PD:2,3*

      A threshold for the next step

      Just ONE of these suggests possible Complex/Advanced PD:

          • 5 or more times per day when oral levodopa is taken

          • 2 or more hours of 'OFF' time every day

          • 1 or more hour of troublesome dyskinesia every day

      A panel was comprised of 17 (with 15 completing all 3 rounds) leading movement disorder specialists from 10 European countries with extensive experience of treating Parkinson's disease patients (mean (SD) = 23.9 ± 6.4 years), between February 2014 and January 2015. Consensus on indicators of suspected Complex/Advanced PD and eligibility for non-oral therapies were based on motor symptoms, non-motor symptoms, and functional impairments. Based on clinical importance, panellists ranked the relative priority of the 15 consensus indicators of suspected Complex/Advanced PD within motor, non-motor, and functional impact domains. AbbVie co-authors were involved in this study.

      The following are fictional case studies, developed solely for educational and illustrative purposes.

      Using '5 or 2 or 1' in practice

      Amir experiences uncontrolled PD. His dosing frequency has exceeded 5 doses per day, so he's reached a threshold to be considered for a non-oral therapy.

      Carol has dementia and, as well as her 4 doses of levodopa, she takes a COMT inhibitor. However, control is increasingly wearing-off and she experiences at least 3 hours of 'OFF' time every day. She's reached a threshold to be considered for a non-oral therapy.

      David's PD is not well controlled. The dose of levodopa has been increased, but there are still unpredictable fluctuations of motor symptoms. David experiences 3 hours of troublesome dyskinesia every day

      COMT=catechol-O-methyltransferase; MAOBi=monoamine oxidase B inhibitor.


      1. DUODOPA (levodopa/carbidopa intestinal gel) Summary of Product Characteristics. Available at: https://www.medicines.org.uk/emc/medicine/20786. Accessed August 2022.
      2. Antonini A. et al. Curr Med Res Opin 2018;34:2063-73.
      3. Santos-Garcia D, et al. Parkinson's Dis 2020;2020:7537924.




      Adverse events should be reported. Reporting forms and information can be found at yellowcard.mhra.gov.uk.

      Adverse events should also be reported to AbbVie on GBPV@abbvie.com 


       UK-DUOD-210225. Date of preparation: August 2022.