Use of advanced therapies for Parkinson's disease in Norway.

Background: Many patients with Parkinson’s disease with severe motor fluctuations benefit from advanced therapies – either deep brain stimulation or continuous infusion therapy with levodopa-carbidopa intestinal gel or apomorphine. In Norway, deep brain stimulation is provided as a shared national or multi-regional service. The treatment is currently available at Oslo University Hospital and St. Olavs Hospital; prior to 2012 it was also available at Haukeland University Hospital. Infusion therapy has no similar geographical restrictions. We therefore wished to examine geographical differences in the use of the two most common forms of advanced therapy for Parkinson’s disease.

Material And Method: The county of residence of all patients receiving deep brain stimulation or infusion therapy with levodopa-carbidopa intestinal gel in the period 2009 – 2013 was recorded using data from hospital episode statistics and the Norwegian Prescription Database, respectively.

Results: A total of 262 patients with Parkinson’s disease began advanced therapy, 146 with deep brain stimulation and 116 with levodopa-carbidopa infusion. Four counties differed significantly from the others in their use of the two methods. Møre og Romsdal, Nordland and Sør-Trøndelag treated a significantly greater proportion of patients with deep brain stimulation, while Rogaland treated a significantly greater proportion with levodopa-carbidopa infusion therapy.

Interpretation: Advanced therapies for Parkinson’s disease are offered throughout Norway, but there are significant geographical differences in the type of therapy initiated. One possible explanation is that patients in different counties receive different information about the therapeutic options available.