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Lookup NU author(s): Professor Nicola PaveseORCiD, Professor Annette Hand
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC 4.0).
BackgroundLevodopa is still the cornerstone of symptomatic treatment for people with Parkinson's disease (PwP). With disease progression and long-term use, PwP can develop motor complications such as wearing off and dyskinesia. There is limited practical guidance on the early identification of motor fluctuations and the optimal timing of adjunctive therapies in clinical practice.ObjectiveTo develop expert consensus on best practices for initiating and monitoring levodopa therapy, recognising early motor fluctuations, incorporating adjunctive therapies, and improving patient education in the management of Parkinson's disease (PD).MethodsA modified Delphi methodology was used. A steering committee (SC) of nine clinicians with experience in managing PD drafted 59 consensus statements across four thematic domains. Statements were developed into an online survey and distributed to a panel of UK-based healthcare professionals (HCPs). Respondents rated their agreement using a four-point Likert scale. Consensus was defined as ≥75% agreement.ResultsA total of 150 HCPs completed the survey, including neurologists, geriatricians, and PD nurse specialists. Consensus was achieved for all 59 statements (100%). Key areas of agreement included early alignment of treatment with individual patient goals, the need for routine monitoring using standardised tools, timely initiation of adjunctive therapies, and the importance of accessible, ongoing patient and caregiver education.ConclusionsThis Delphi consensus provides a set of expert-derived, clinically applicable recommendations to support proactive and individualised management of PD. Adoption of these practices may enhance the recognition and treatment of motor fluctuations, improve patient quality of life, and support better long-term outcomes.Experts agree on best practices for managing Parkinson's diseasePlain Language SummaryWhy was the study done?Levodopa is a key medicine for treating Parkinson's disease, helping with symptoms like stiffness and slow movement. Over time, though, some people notice changes in how well their medication works during the day. This can mean the effects wear off too soon or cause involuntary movements called dyskinesia.Healthcare professionals do not have much practical guidance on how to spot these problems early, when to add new treatments, or how to best support people with Parkinson's and their caregivers.This study brought experts together to create useful recommendations for better care.What did the researchers do?Nine UK experts who treat Parkinson's disease came up with 59 statements about different parts of care, like starting and monitoring levodopa, noticing early changes in movement, adding new medicines,and teaching patients and caregivers. They shared these statements with 150 healthcare professionals, including neurologists, geriatricians, and nurse specialists, who rated how much they agreed with each one. If 75% or more agreed, the statement was considered a consensus.What did the researchers find?All 59 statements reached full agreement from the group. The main recommendations were to start treatment based on each person's goals and needs, check symptoms regularly with standard tools, add new therapies at the right time to prevent problems, and make sure people with Parkinson's and their caregivers get ongoing, easy-to-understand education and support.What do the findings mean?The experts agreed on clear best practices to help healthcare professionals give more proactive and personalised care to people with Parkinson's disease. Using these recommendations may help spot movement problems sooner, improve symptom control, and boost patients' quality of life over time.
Author(s): Pavese N, Evans J, Hand A, Newman EJ, Duncan G, Martin H, Ebenezer L, Mohamed B, Lassman E, Barnett J, Morgante F
Publication type: Article
Publication status: Published
Journal: Journal of Parkinson's disease
Year: 2026
Volume: 16
Issue: 3
Pages: 563-577
Print publication date: 01/05/2026
Online publication date: 09/03/2026
Acceptance date: 09/02/2026
Date deposited: 01/06/2026
ISSN (print): 1877-7171
ISSN (electronic): 1877-718X
Publisher: Sage Publications
URL: https://doi.org/10.1177/1877718X261427577
DOI: 10.1177/1877718X261427577
Data Access Statement: All data relevant to the study are included in the article
PubMed id: 41800826
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