Parkinson's Disease - Evidence of neuroprotection essential to progress treatment dynamics
Scope
Report Highlights
Reasons to Purchase
Table of Contents
- ABOUT DATAMONITOR HEALTHCARE - page 2
- About the central nervous system pharmaceutical analysis team - page 2
- CHAPTER 1 EXECUTIVE SUMMARY - page 3
- Scope of the analysis - page 3
- Datamonitor insight into the Parkinson's disease market - page 3
- Contributing experts - page 6
- Related reports - page 6
- CHAPTER 2 INTRODUCTION AND SCOPE - page 8
- Coverage of the Stakeholder Insight Survey - page 8
- Disease definition and epidemiology - page 9
- Presentation, diagnosis and comorbidities - page 9
- Pharmacological treatment trends - page 9
- Key prescribing influences - page 9
- Treatment outcomes and surgery - page 9
- Future trends - page 10
- Coverage of the Stakeholder Insight Survey - page 8
- CHAPTER 3 COUNTRY TREATMENT TREES - page 11
- Introduction to treatment trees - page 11
- First-line treatment trees - page 12
- US - page 12
- Japan - page 13
- France - page 14
- Germany - page 15
- Italy - page 16
- Spain - page 17
- UK - page 18
- Second-line treatment trees - page 19
- US - page 19
- Japan - page 20
- France - page 22
- Germany - page 23
- Italy - page 25
- Spain - page 26
- UK - page 28
- CHAPTER 4 EPIDEMIOLOGY AND PATIENT SEGMENTATION - page 30
- Disease definition - page 31
- The etiology of PD is not yet clear - page 31
- Parkinson's disease is typically classified by the Hoehn and Yahr scale - page 32
- Patient population is generally well spread across the three disease severities - page 33
- Epidemiology of Parkinson's disease - page 36
- Parkinson's disease rarely affects adults younger than 50 years of age - page 37
- Prevalence of Parkinson's disease - page 38
- Over 1.4 million individuals across the US, Japan and 5EU are estimated to suffer from PD - page 39
- European and Japanese epidemiology studies - page 40
- Italy - page 40
- UK - page 41
- Japan - page 42
- Disease definition - page 31
- CHAPTER 5 PRESENTATION, DIAGNOSIS AND COMORBIDITIES - page 43
- Presentation - page 44
- Time to presentation - page 44
- Early symptoms are generally very subtle and often go unnoticed - page 44
- Improving presentation rates - page 46
- Internet and patient advocacy groups are essential awareness drivers - page 46
- Improved education of the public and primary care physicians is needed - page 47
- The four common presentations of PD - page 48
- Tremor - page 48
- Rigidity - page 49
- Akinesia and bradykinesia - page 49
- Postural instability - page 50
- Time to presentation - page 44
- Diagnosis - page 50
- An accurate diagnosis of PD comes from combined neurological, laboratory and imaging evaluations - page 50
- Neurological evaluation of PD - page 52
- Laboratory evaluation of PD - page 55
- Imaging studies for PD - page 56
- Delays in the diagnosis of PD - page 59
- Misdiagnosis is as high as 20-30% in the early stages - page 59
- It takes on average 13 weeks from presentation to a physician to an accurate diagnosis of PD - page 59
- Differential diagnosis to rule out other possible neurological conditions - page 61
- More than half of prevalent early-stage PD patients remain undiagnosed - page 62
- Over 80% of patients are characterized as having either early- or mid-stage PD at diagnosis - page 65
- An accurate diagnosis of PD comes from combined neurological, laboratory and imaging evaluations - page 50
- Comorbidities (non-motor symptoms) of PD - page 67
- Depression is the most common comorbidity at each stage of the disease - page 68
- Depression - page 69
- Dementia - page 69
- Psychosis - page 70
- Sleep disturbances - page 70
- Depression is the most common comorbidity at each stage of the disease - page 68
- Presentation - page 44
- CHAPTER 6 TREATMENT OPTIONS AND GUIDELINES - page 71
- Treatment options - page 72
- Non-pharmacological treatment - page 72
- Non-pharmacological only approaches are largely shelved once mid-stage PD is reached - page 72
- Pharmacological treatment - page 74
- Dopaminergics - page 74
- Dopamine agonists - page 76
- Catechol-O-methyltransferase inhibitors - page 78
- Monoamine oxidase inhibitors - page 80
- Other treatments - page 81
- Surgical treatment - page 83
- Surgery becomes an option when PD symptoms cannot be adequately controlled with medication - page 83
- Deep brain stimulation is now the current standard surgical practice for PD - page 84
- Duodopa pump provides continuous dopaminergic stimulation - page 86
- Non-pharmacological treatment - page 72
- Treatment guidelines - page 86
- The treatment of PD is a highly individualized process - page 86
- US-guidelines based on AAN recommendations - page 87
- New guidelines issued by the AAN in 2006 are more proscriptive than prescriptive - page 88
- UK-National Institute for Health and Clinical Excellence guidelines - page 89
- Recommended pharmacological therapy in early PD - page 90
- Recommended pharmacotherapy in later PD - page 91
- Guidance on surgery for PD - page 93
- Other guidelines by region - page 94
- Treatment options - page 72
- CHAPTER 7 PRESCRIBING TRENDS IN PARKINSON'S DISEASE - page 95
- Pharmacological prescribing trends - page 96
- Caveats-prescribing trends - page 96
- Seven major market overview of prescribing trends - page 96
- A greater proportion of patients progress to second-line therapy as the disease severity advances - page 96
- Physician type responsible for initial prescription of PD therapy - page 97
- Neurologists make the majority of initial treatment decisions for PD in the 7MMs - page 97
- Role of pharmacological treatment in the management of PD - page 99
- UK neurologists report waiting the longest period of time before initiating pharmacological therapy once early-stage PD has been diagnosed - page 99
- Pharmacological therapy is not deemed essential in patients characterized as having early-stage PD - page 102
- Pharmacological and non-pharmacological therapy is combined in more than half of all advanced-stage PD patients in Germany and the UK - page 103
- Prescribing trends in early-stage PD - page 105
- The proposed neuroprotective properties of the MAO-B inhibitors and dopamine agonists are still to be proven - page 105
- Age and symptom severity dictates first-line therapy decisions - page 106
- Boehringer Ingelheim's pramipexole (Mirapex) leads the way in first-line early-stage PD management - page 108
- Initiation of pharmacological therapy with levodopa remains high - page 110
- First-line selegiline monotherapy is rarely seen - page 111
- Monotherapy largely dominates early-stage PD management - page 111
- Some 40% of early-stage patients progress to second-line therapy within 20 months - page 112
- 60% of early-stage PD patients who progress to second-line therapy have a drug added-on to their first-line regimen - page 113
- Levodopa-carbidopa or levodopa monotherapy are the most commonly added-on products at second-line for early-stage PD - page 113
- Pramipexole and ropinirole are the most common second-line regimens switched to at early-stage - page 116
- Prescribing trends in mid-stage PD - page 118
- Fixed-dose combinations containing levodopa and dopamine agonist therapy make up first-line therapy for mid-stage PD - page 119
- Levodopa-carbidopa therapy is prescribed first-line to a fifth of all mid-stage PD patients in the US - page 119
- Over half of all mid-stage PD patients receive combination therapy - page 121
- 50% of mid-stage patients progress to second-line therapy within 2 years - page 122
- Adding-on accounts for the greater proportion of second-line dynamics for mid-stage PD - page 123
- Entacapone is the most commonly added-on therapy at second-line in mid-stage PD - page 123
- Second-line mid-stage PD sees like-for-like dopamine agonist switching and movement towards more complex fixed-dose combination products - page 125
- Prescribing trends in advanced-stage PD - page 128
- Levodopa-carbidopa fixed-dose combination products dominate first-line therapy for advanced PD - page 129
- Monotherapy is rare in advanced-stage PD - page 130
- Over 70% of UK patients progress to second-line therapy for advanced-stage PD - page 131
- Neurologists continue to add-on therapy in the majority of advanced PD cases - page 132
- Amantadine and rasagiline are highly popular add-ons in second-line for advanced PD - page 133
- Apomorphine adding-on is highest in France and Spain - page 135
- Levodopa-benserazide viewed as a second-line alternative to levodopa-carbidopa - page 138
- Pharmacological prescribing trends - page 96
- CHAPTER 8 PRESCRIBING INFLUENCES AND BRAND ASSESSMENT - page 140
- Factors influencing physician decision making - page 141
- Side-effect profile is the number one influential factor - page 143
- Mid- and advanced-stage pharmacotherapy is governed by managing the side effects of levodopa - page 144
- Dopamine agonist side effects are mostly cognitive in nature - page 145
- A drugs ability to reduce OFF periods has a high influence on prescribing decisions - page 145
- The goals of therapy are to reduce OFF periods as much as possible - page 146
- Ability to minimize dyskinesias was rated the most influential attribute in Japan - page 147
- Ability to use as either monotherapy or adjunctive therapy becomes more influential as the disease progresses - page 148
- Ability to delay the use of levodopa therapy influences only initial treatment decisions - page 149
- Ability to enhance the benefit of levodopa therapy has led to the development of a number of products - page 149
- Side-effect profile is the number one influential factor - page 143
- Physician perception of key brands - page 150
- Neurologists in Japan are most satisfied with current therapies - page 151
- Interpreting a brand map - page 152
- Brand comparison shows levodopa remains the "gold standard" symptomatic PD treatment - page 154
- Sinemet (carbidopa-levodopa) - page 156
- Parcopa (carbidopa-levodopa) - page 159
- Madopar (levodopa-benserazide) - page 160
- Stalevo (carbidopa-levodopa-entacapone) - page 162
- The dopamine agonists and now Azilect continue to battle it out for market position - page 169
- Requip (ropinirole) - page 171
- Mirapex (pramipexole) - page 174
- Neupro (rotigotine) - page 177
- Apokyn (apomorphine) - page 184
- Azilect (rasagiline) - page 188
- Comtan (entacapone) - page 191
- Factors influencing physician decision making - page 141
- CHAPTER 9 TREATMENTS OUTCOMES AND SURGERY - page 194
- Treatment outcomes - page 195
- Only 36% of advanced-stage patients are adequately controlled by pharmacological therapy - page 195
- Intolerable side effects are the key reason for discontinuing or switching treatment - page 197
- Although pill burden affects patient quality of life, it has a low influence on discontinuing or switching therapies - page 197
- Surgical treatment of Parkinson's disease - page 198
- Progression to surgery - page 198
- More than half of the 9% of PD patients who require surgery go on to receive it - page 198
- The invasive nature of surgical techniques limits their use - page 200
- Surgical techniques used - page 202
- Deep Brain Stimulation is by far the most common surgical technique used across the seven major markets - page 202
- Outcome of surgery - page 204
- Over 50% of patients will experience both a reduction in PD symptoms and a reduction in the dose of pharmacological medication with each surgical technique - page 204
- Progression to surgery - page 198
- Treatment outcomes - page 195
- BIBLIOGRAPHY - page 207
- Journal papers - page 207
- Websites - page 213
- APPENDIX A - page 217
- Physician research methodology - page 217
- Physician sample breakdown - page 217
- US - page 217
- Japan - page 218
- France - page 218
- Germany - page 219
- Italy - page 219
- Spain - page 220
- UK - page 220
- Physician sample breakdown - page 217
- Contributing experts - page 221
- Physician research methodology - page 217
- APPENDIX B - page 222
- The survey questionnaire - page 222
- Physician's details - page 222
- Screening questions - page 223
- INTRODUCTION - page 224
- Section 1-Patient segmentation and diagnosis of Parkinson's disease - page 224
- Section 2-Treatment of Parkinson's disease - page 230
- Early-stage pharmacological treatment - page 232
- Mid-stage pharmacological treatment - page 235
- Advanced-stage pharmacological treatment - page 239
- Section 3-Key prescribing factors - page 243
- Section 4-Treatment outcomes and Surgery - page 246
- Demographics - page 249
- Disclaimer - page 251
- The survey questionnaire - page 222
- List of Tables
- Table 1: The five stages of PD according to the Hoehn and Yahr scale - page 33
- Table 2: Prevalence of PD across the seven major markets, 2007 - page 39
- Table 3: Unified Parkinson's Disease Rating Scale-cognition, behavior and mood - page 54
- Table 4: Proportion of prevalent PD population diagnosed at each disease stage across the seven major markets, 2007 - page 64
- Table 5: Options for initial pharmacotherapy in early PD as proposed in NICE guidelines, 2006 - page 91
- Table 6: Options for adjuvant pharmacotherapy in later PD as proposed in NICE guidelines, 2006 - page 92
- Table 7: Percentage of interviewed neurologists selecting each regimen as a first-line therapy for early-stage PD, 2007 - page 108
- Table 8: Early-stage PD second-line therapy patient progression details, 2007 - page 112
- Table 9: Percentage of drugs added-on at second-line to the dopamine agonists selected for first-line early-stage PD therapy across the seven major markets, 2007 - page 115
- Table 10: Most common selected second-line regimens after switching from first-line dopamine agonist monotherapy for early-stage PD across the seven major markets, 2007 - page 117
- Table 11: Percentage of interviewed neurologists selecting each regimen as a first-line therapy for mid-stage PD, 2007 - page 119
- Table 12: Percentage of patients receiving each drug regimen as first-line for mid-stage PD, 2007 - page 121
- Table 13: Mid-stage PD second-line therapy patient progression details, 2007 - page 122
- Table 14: Advanced-stage PD second-line therapy patient progression details, 2007 - page 132
- Table 15: Factors that influence drug choice for the management of PD, 2007 - page 142
- Table 16: Number and percentage of neurologists able to rate each brand - page 150
- Table 17: Overall performance of each Parkinson's disease drug against six attributes according to interviewed neurologists in the seven major markets, 2007 - page 151
- Table 18: The overall performance of each drug against all attributes, and with attribute weightings applied - page 154
- Table 19: Sinemet's attribute scores, by country - page 158
- Table 20: Comparison of Parcopa's and Sinemet's US attribute scores - page 160
- Table 21: Madopar's attribute scores, by country - page 161
- Table 22: Stalevo's attribute scores, by country - page 164
- Table 23: Requip's attribute scores, by country - page 172
- Table 24: Mirapex's attribute scores, by country - page 176
- Table 25: Neupro's attribute scores, by country - page 179
- Table 26: Apokyn's attribute scores, by country - page 185
- Table 27: Treatment-emergent adverse events (incidence ≥10%) and associated rate of discontinuation during open-label long-term use of Apokyn (n=550) - page 187
- Table 28: Azilect's attribute scores, by country - page 190
- Table 29: Comtan's attribute scores, by country - page 192
- Table 30: Reasons for patients discontinuing a therapy/switching to an alternative drug therapy on a scale of 1 to 10, where 1=factor of low influence and 10=factor of high influence, 2006 - page 197
- Table 31: US-physician sample breakdown, 2007 - page 217
- Table 32: Japan-physician sample breakdown, 2007 - page 218
- Table 33: France-physician sample breakdown, 2007 - page 218
- Table 34: Germany-physician sample breakdown, 2007 - page 219
- Table 35: Italy-physician sample breakdown, 2007 - page 219
- Table 36: Spain-physician sample breakdown, 2007 - page 220
- Table 37: UK-physician sample breakdown, 2007 - page 220
- List of Figures
- Figure 1: Diagrammatic overview of the coverage of the Stakeholder Insight: Parkinson's Disease survey, 2007 - page 8
- Figure 2: Parkinson's disease treatment tree split by disease severity in the US, 2007 - page 12
- Figure 3: Parkinson's disease treatment tree split by disease severity in Japan, 2007 - page 13
- Figure 4: Parkinson's disease treatment tree split by disease severity in France, 2007 - page 14
- Figure 5: Parkinson's disease treatment tree split by disease severity in Germany, 2007 - page 15
- Figure 6: Parkinson's disease treatment tree split by disease severity in Italy, 2007 - page 16
- Figure 7: Parkinson's disease treatment tree split by disease severity in Spain, 2007 - page 17
- Figure 8: Parkinson's disease treatment tree split by disease severity in the UK, 2007 - page 18
- Figure 9: Second-line early-stage Parkinson's disease treatment dynamics in the US, 2007 - page 19
- Figure 10: Second-line mid-stage Parkinson's disease treatment dynamics in the US, 2007 - page 19
- Figure 11: Second-line advanced-stage Parkinson's disease treatment dynamics in the US, 2007 - page 20
- Figure 12: Second-line early-stage Parkinson's disease treatment dynamics in Japan, 2007 - page 20
- Figure 13: Second-line mid-stage Parkinson's disease treatment dynamics in Japan, 2007 - page 21
- Figure 14: Second-line advanced-stage Parkinson's disease treatment dynamics in Japan, 2007 - page 21
- Figure 15: Second-line early-stage Parkinson's disease treatment dynamics in France, 2007 - page 22
- Figure 16: Second-line mid-stage Parkinson's disease treatment dynamics in France, 2007 - page 22
- Figure 17: Second-line advanced-stage Parkinson's disease treatment dynamics in France, 2007 - page 23
- Figure 18: Second-line early-stage Parkinson's disease treatment dynamics in Germany, 2007 - page 23
- Figure 19: Second-line mid-stage Parkinson's disease treatment dynamics in Germany, 2007 - page 24
- Figure 20: Second-line advanced-stage Parkinson's disease treatment dynamics in Germany, 2007 - page 24
- Figure 21: Second-line early-stage Parkinson's disease treatment dynamics in Italy, 2007 - page 25
- Figure 22: Second-line mid-stage Parkinson's disease treatment dynamics in Italy, 2007 - page 25
- Figure 23: Second-line advanced-stage Parkinson's disease treatment dynamics in Italy, 2007 - page 26
- Figure 24: Second-line early-stage Parkinson's disease treatment dynamics in Spain, 2007 - page 26
- Figure 25: Second-line mid-stage Parkinson's disease treatment dynamics in Spain, 2007 - page 27
- Figure 26: Second-line advanced-stage Parkinson's disease treatment dynamics in Spain, 2007 - page 27
- Figure 27: Second-line early-stage Parkinson's disease treatment dynamics in the UK, 2007 - page 28
- Figure 28: Second-line mid-stage Parkinson's disease treatment dynamics in the UK, 2007 - page 28
- Figure 29: Second-line advanced-stage Parkinson's disease treatment dynamics in the UK, 2007 - page 29
- Figure 30: Proportion of diagnosed PD patients suffering from each disease severity, 2007 - page 34
- Figure 31: PD progression timeline from onset of early-stage disease to death as indicated by interviewed neurologists, 2007 - page 36
- Figure 32: Age at diagnosis for each stage of PD, 2007 - page 37
- Figure 33: Average time in months from the onset of symptoms of PD to initial presentation to a physician, 2007 - page 45
- Figure 34: Percentage of neurologists using each diagnostic imaging technique to make a diagnosis of PD, 2007 - page 57
- Figure 35: The number of weeks between presentation to a physician and an accurate diagnosis of PD, 2007 - page 60
- Figure 36: Percentage of prevalent PD population diagnosed vs undiagnosed for each disease stage, 2007 - page 63
- Figure 37: Proportion of interviewed neurologists' PD patients characterized as having each stage of the disease, 2007 - page 66
- Figure 38: Proportion of interviewed neurologists' PD patients with each severity of the disease at initial diagnosis, 2007 - page 67
- Figure 39: Proportion of PD patients suffering with each comorbidity at the three stages of the disease, 2007 - page 68
- Figure 40: Mean percentage of pharmacological and non-pharmacological PD therapy across the seven major markets, 2007 - page 73
- Figure 41: Mechanism of action of levodopa therapy - page 74
- Figure 42: Mechanism of action of AADC inhibitors (DDIs) - page 75
- Figure 43: Mechanism of action of COMT inhibitor (entacapone) - page 79
- Figure 44: Mechanism of action of MAO-B inhibitors - page 81
- Figure 45: Pharmacological treatment algorithm for PD - page 87
- Figure 46: The dynamics of pharmacological treatment in PD management, 2007 - page 97
- Figure 47: Physician type breakdown of the initial treatment decision of PD in the seven major markets, 2007 - page 98
- Figure 48: Weeks between diagnosis of PD and the initiation of pharmacological therapy by disease stage, 2007 - page 100
- Figure 49: Percentage of patients receiving pharmacological therapy for PD across the seven major markets by stage, 2007 - page 102
- Figure 50: Percentage of patients receiving pharmacological and non-pharmacological therapy for PD across the seven major markets by stage, 2007 - page 103
- Figure 51: Early-stage second-line management strategies for pramipexole across the seven major markets, 2007 - page 105
- Figure 52: First-line treatment regimens for early-stage PD in the seven major markets, 2007 - page 109
- Figure 53: Monotherapy vs combination therapy split for early-stage PD management, 2007 - page 111
- Figure 54: Patients who progress to second-line early-stage PD therapy and receive add-on or are switched, 2007 - page 113
- Figure 55: Second-line drug add-ons for early-stage PD in the seven major markets, 2007 - page 114
- Figure 56: Most common drug regimens switched to at second-line for early-stage PD across the seven major markets, 2007 - page 116
- Figure 57: Mid-stage second-line management strategies for levodopa-carbidopa (Sinemet, Parcopa) across the seven major markets, 2007 - page 118
- Figure 58: First-line treatment regimens for mid-stage PD in the seven major markets, 2007 - page 120
- Figure 59: Monotherapy and combination therapy split for mid-stage PD management, 2007 - page 122
- Figure 60: Patients who progress to second-line mid-stage PD therapy and receive add-on or switch, 2007 - page 123
- Figure 61: Second-line drug add-ons for mid-stage PD in the seven major markets, 2007 - page 124
- Figure 62: Most common drug regimens switched to at second-line for mid-stage PD across the seven major markets, 2007 - page 126
- Figure 63: Advanced-stage second-line management strategies for levodopa-carbidopa (Sinemet, Parcopa) across the seven major markets, 2007 - page 128
- Figure 64: First-line treatment regimens for advanced-stage PD in the seven major markets, 2007 - page 129
- Figure 65: Monotherapy and combination therapy split for advanced-stage PD management, 2007 - page 131
- Figure 66: Patients who progress to second-line advanced-stage PD therapy and receive add-on or switch, 2007 - page 132
- Figure 67: Second-line drug add-ons for advanced-stage PD in the seven major markets, 2007 - page 133
- Figure 68: Number of times neurologists added on Apokyn in second-line for advanced-stage PD across the seven major markets, 2007 - page 136
- Figure 69: Most common drug regimens switched to at second-line for advanced-stage PD across the seven major markets, 2007 - page 139
- Figure 70: Average rating of factors which influence drug choice for the management of PD, 2007 - page 141
- Figure 71: Neurologist's scores of side-effect profile, by brand - page 143
- Figure 72: Importance of a drug's ability to minimize dyskinesias on prescribing decisions by country, 2007 - page 147
- Figure 73: Overview brand map of attributes versus brand perception - page 153
- Figure 74: Physician perception of levodopa-based combination products - page 155
- Figure 75: Levodopa-based combination brand map of attributes versus brand perception - page 156
- Figure 76: PD-specific Sinemet sales, 2003-06 - page 157
- Figure 77: Sinemet map, country preference to prescribing attributes - page 159
- Figure 78: PD-specific Madopar sales, 2003-06 - page 161
- Figure 79: Madopar's attribute scores, by country - page 162
- Figure 80: PD-specific Stalevo sales, 2003-06 - page 163
- Figure 81: Stalevo's attribute scores, by country - page 164
- Figure 82: Proportion of patients receiving Stalevo at first-line for each stage of PD, 2007 - page 166
- Figure 83: Physician perception of the dopamine agonists, Azilect and Comtan - page 169
- Figure 84: Non-levodopa containing product brand map of attributes versus brand perception - page 170
- Figure 85: PD-specific Requip sales, 2003-06 - page 171
- Figure 86: Requip's overall attribute scores - page 173
- Figure 87: PD-specific Mirapex sales, 2003-06 - page 175
- Figure 88: Mirapex and Requip overall attribute scores - page 177
- Figure 89: Diagrammatic representation of Neupro's mode of action - page 178
- Figure 90: PD-specific quarterly Neupro sales in Germany, Spain and the UK, Q3-2006-Q2-2007 - page 181
- Figure 91: Country rating of Neupro, Requip and Mirapex on the ability to use as either monotherapy or adjunctive therapy - page 182
- Figure 92: Proportion of patients receiving Neupro at first-line for each stage of PD, 2007 - page 183
- Figure 93: Apokyn's overall attribute scores - page 186
- Figure 94: PD- specific quarterly US Apokyn sales, Q1 2006-Q2 2007 - page 188
- Figure 95: PD- specific Azilect sales, H2 2005-H1 2007 - page 189
- Figure 96: Percentage of patients adequately controlled by pharmacological therapy at each stage of the disease as indicated by interviewed neurologists across the seven major markets, 2007 - page 195
- Figure 97: Percentage of PD patients requiring and receiving surgery across the seven major markets, 2007 - page 199
- Figure 98: Ratings of the reasons why patients do not receive surgery in the seven major markets, 2007 - page 200
- Figure 99: Percentage of neurologists with patients who receive surgery utilizing each PD surgical technique, 2007 - page 203
- Figure 100: Percentage of patients who undergo surgery and receive each surgical technique, 2007 - page 204
- Figure 101: Mean percentage of patients for whom each surgical technique results in a reduction in Parkinson's disease symptoms and a reduction in the dose of pharmacological medication across the seven major markets, 2007 - page 205
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