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PDMonitor interview with Professor K Ray Chaudhuri and Nikos Moschos

PDMonitor interview with Professor K Ray Chaudhuri and Nikos Moschos

PDMonitor interview with Professor K Ray Chaudhuri and Nikos Moschos

Monitoring closely the visible and hidden part of Parkinson’s disease, is now possible thanks to the pioneering PDMonitor ®, a wearable sensor-based care device.
Nikos Moschos, Founder and Business Director of PD Neurotechnology® and Professor of Movement Disorders & Neurology, K Ray Chaudhuri, describe this development as a great medical advance in the treatment strategy for Parkinson’s disease.

My name is Nikos Moschos, I am the Business Director and Co-Founder of PD Neurotechnology®.
PD Neurotechnology® is a Medical Device Company, it was founded in 2015 in the UK
and it is now in sales in a number of countries all over Europe. Its first product is called PDMonitor®, which is a medical device, certified with a CE mark and soon with a CA in the UK that supports the continuous objective monitoring of Parkinson’s disease patients and enables a paradigm shift in the management of the disease. We have more than 500 patients who have been using the device in the last 2 years. Most of the patients are either stable or getting better.
We still need to validate that, but this makes us very enthusiastic because it’s a major breakthrough in the management of the disease.

My name is Ray Chaudhuri I’m a Professor of Neurology and Movement Disorders, I’m the Director of the Parkinson’s Centre of Excellence at Kings College and Kings College Hospital and also an Academic Lead and Professor here at the Dementech Academic Neurosciences Centre. There is the visible part of Parkinson’s, which is often the tremor or the stiffness but also the invisible part, what I call the hidden face of Parkinson’s. So to monitor these, all these problems within the context of a short clinic that we can often offer, either in the NHS or in the private sector, is often not possible. We should be able to monitor people’s condition changes from time-to-time at home and really management of that gives somebody a real hold on their clinical improvement and their quality of life and the PDMonitor® provides us with that, it allows us to monitor people wearing these sensors at home, it gives us a dashboard of their symptoms which I can access and the patient can access using a cloud-based system. It then allows us to monitor and initiate changes in therapy, both, either pharmacological or non-pharmacological to make improvements in these aspects such as their mobility, such as dyskinesias, problems that we are often unable to address properly by simply history taking.
The wearable sensor-based care, which allows us to have a dashboard-based triggered treatment strategy is therefore a great advance.

Important feedback about PDMonitor® comes from real life. We have more than 500 patients that have been using the device in the last 2 years (until May 2022) and its use in daily practice already shows that PDMonitor® could be a major breakthrough in the management of the disease.
Learn more about how PDMonitor® possibly changes the daily living of Parkinson’s patients, in an interview with K Ray Chaudhuri, Professor of Movement Disorders & Neurology and Nikos Moschos, Founder and Business Director of PD Neurotechnology®.

Preliminary feedback about PDMonitor comes from clinical studies but most importantly it comes from real life. We have more than 500 patients who have been using the device in the last 2 years and it shows, the evidence behind that shows, directionally, we still need to validate things, we still need to make sure that the hypothesis we’re testing and the preliminary results are valid, it’s first of all that the vast majority of the patients find it easy to use.

It shows that a big majority of the patients also use the mobile app, which is not self-intuitive because these are older patients that are not so familiar with smartphones.

It also shows that patients are doing better or are stable through time. The majority of patients. Now that is actually a major breakthrough because this is by nature a neurodegenerative disease so you would expect the patient to become worse through time. Preliminary evidence shows that a small minority of patients get worse, whereas you would expect most of the patients to get worse and on the contrary most of the patients are either stable or getting better, we still need to validate that, but this makes us very enthusiastic because it’s a major breakthrough in the management of the disease.

There’s a number of reasons why PDMonitor is actually a major breakthrough. First of all, it supports a paradigm shift in the course of a global pandemic, the numbers are really skyrocketing, patients expected to double, and it’s a case study of digital transformation and digital care at home. This on its own is very important because there’s a global trend to take the patient out of the hospital, keep them at home and then at home, optimize and manage these types of diseases. Now, Parkinson’s on its own despite the fact that it doesn’t affect too many people, still is a very costly disease, and also a disease with no cure. So this costly disease is now possibly managed by technology that helps, possibly, save costs, possibly improve quality of life, possibly improve the life of the people around the patient and that has a global impact associated with a high cost of the disease.

We are actually very, I don’t know how to say it, very emotionally satisfied by the fact that recent technology that people adhere to, people like it, and people see the benefit. So we see patients saying that “it has changed my life”, we see patients saying “now I can communicate better with my Physician”, we can see patients saying “I can explain now better how I’m doing and I can communicate with my Physician in a way that helps me become a better patient.” So overall, we see a great causality effect between streamlining of the medication, improvement of the quality of life, improvement of satisfaction, and essentially having the patients lead better lives. This is what keeps us going and this is what makes us very excited about PDMonitor.

I think in terms of the paradigm shift of our management strategy in Parkinson’s it’ll be very normal, however such paradigm shift is already occurring in many other conditions, diabetes for instance, some of the cancer management, some of the other chronic neurodegenerative, chronic long-term conditions, management is now often focused on management of the patient at home, epilepsy is another example where at home monitoring is booming increasingly relevant and important. Now I think this is going to be the situation with Parkinson’s, as Neurologists we have been very conservative, we still feel that face to face examination is the ultimate, ultimate strategy of care and quality standard of care, however we have to also think about the patient and the carers, people who might live far away and some of them who might be making a travel for 3 to 4 hours for a 20 minute consultation. In such case, that ability for us to monitor how they are at home and the ability of the patient to report back and to look at their own symptoms and the ability for us thereafter to manage the symptoms by treatment changes is a tremendous advance and I think once this is evaluated in all the regulatory manner, there is a real chance this will be incorporated in standard clinical practice.

PDMonitor® is a medical device that supports the continuous, remote, objective monitoring of Parkinson’s disease patients and enables a paradigm shift in the management of the disease.
Find out more about the key advantages of PDMonitor® for patients and physicians, in an interview with K Ray Chaudhuri, Professor of Movement Disorders & Neurology and Nikos Moschos, Founder and Business Director of PD Neurotechnology®.

PDMonitor is a medical device, certified with a CE mark and soon with a UK CA in the UK that supports the continuous objective monitoring of Parkinson’s disease patients and enables a paradigm shift in the management of the disease.

A medical device is not a gadget. It has strenuous, regulatory certifications, it follows specific rules in order to be able to be marketed because it is supposed to be used in clinical practice. So a key difference between commercial gadgets and the commercial medical devices is all the regulatory framework around the devices.

PDMonitor monitors all motor symptoms of the disease except rigidity so it also monitors gait impairment, postural instability, freezing of gait, and also it monitors left to right differences in the exacerbation of the symptomatology. This is very important because this disease being very tough to manage and you want all your activity, you want to have a full understanding of the therapy type of the patient, so it’s important that this device can offer all this symptomatology depiction compared to others that cannot do that.

The second difference has to do with the cloud infrastructure. PDMonitor does not need to be back and forth to a base, to a hospital, and then like a holter, sent back to the patient it can stay at the patient’s home as long as needed so you can do continuous optimization, you can do habitual screening across time, and in this combines both staging of the disease across time and treatment optimization when you see that there is a change.

Data is kept for long, based on GDPR we keep the data for 10 years. So you have a powerful electronic base and record with all the trajectory of the patient’s course in the disease through time so you can compare with the past and also you can understand what has happened and possibly anticipate what could happen in the future.

The mobile app is there in order to be able to capture the timing and type of medication, the timing and type of nutrition but also the non-motor symptoms. And also it gives feedback to the patient about how well they’re doing in a very simple graph, in a very simple statistic that, like a FitBit, helps the patient know that they’re doing better or worse and hopefully stimulate them to increase the efforts, wear the device, use the mobile app, and be self managed.

It enables the Physicians to have a holistic view of the patient’s progress in the disease, it supports treatment optimization because you can have a combination, a comparison between the treatment changes and the impact of those changes so that there is a self-features loop between impact and causality. And also because of the fact that the device stays at home, it helps the Physician always know how the patient is doing and put the patient on a screening program in order to do continuous staging and treatment optimization of the patient.
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The PDMonitor allows us to evaluate the patient’s condition in a dynamic manner at home and that really is a massive unmet need for us because the traditional model of care is based on clinic interviews, perhaps looking at diaries, clinical consultation and is often fraught with inaccuracies because patient’s observation when in the clinic might be very different to how they are at home and diary-based assessments can also be erroneous because patients can fill up diaries retrospectively and there is a thing called ‘recall bias’ so the monitor allows us to look at what one of my colleagues Helmich and Bloem coined the term the ‘Hidden Sorrows’ of people with Parkinson’s so it allows us to look at how their movements are at home, how their tremor is at home, how their mobility is at home, and allow us to adjust and optimise treatment accordingly so I think the ability to do virtual care based on a triggered dashboard-based score is one of its greatest advantages and it of course then ticks the strategy forthcoming strategy of the NHS to provide care, more community and home care in a remote based model.

It allows us to monitor people wearing these sensors at home it gives us a dashboard of their symptoms which I can access and the patient can access using a web based, cloud based system. It then allows us to monitor and initiate changes in therapy, both, either pharmacological or non-pharmacological to make improvements in these aspects such as their mobility, such as dyskinesias, such as slowness, such as stiffness, more importantly also gait, their movement, risk of falls difficulty with initiation of gait, freezing of gait, problems that we are often unable to address properly by simply history taking, and problems that if not addressed properly makes people isolated and that then leads to a vicious cycle of generation of depression, of anxiety, of apathy, sleep disturbances and some people even think it can lead to cognitive disturbances, so the wearable sensor-based care, which allows us to have a dashboard-based triggered treatment strategy is therefore a great advance.

The monitoring allows us to really evaluate the person at home and that’s critically important because the care that we provide for people with Parkinson’s is really based on whether or not the patient’s condition is improving at home and thereby improving the quality of life, not just of the patient, but also the carer…

One of the main unmet needs in the management and follow up of Parkinson’s patients has to do with the understanding of how the patients are doing at home. PDMonitor® sheds light on the daily living of Parkinson’s patients and on the symptomatology at home. Find out more about the ways that PDMonitor® covers unmet needs in Parkinson’s disease management, in an interview with K Ray Chaudhuri, Professor of Movement Disorders & Neurology and Nikos Moschos, Founder and Business Director of PD Neurotechnology®.

One of the main unmet needs in the management and the follow up of Parkinson’s patients, has to do with the understanding of how the patients are doing at home. Because this disease is followed after the symptoms, and you need to know what the symptoms look like in the day to day setting of the patient. PDMonitor sheds light on the daily living, sheds light on the symptomatology at home. On top of that, it helps the patient interact with the physician, give feedback about the timing and type of medication, the timing and type of nutrition, and also the non-motor symptoms, so overall PDMonitor helps liaise better, the patient with the treating physician and the caregiver at home in order to support a possible paradigm shift in the course of the management of the disease.

Parkinson’s is now considered the fastest growing neurodegenerative condition in the world, the numbers of Parkinson’s worldwide are estimated to double by years 2030 to 2040. This would pose an enormous societal cost pressure on patients and carers and healthcare systems around the world because people with Parkinson’s live almost a normal lifespan, once you’re diagnosed you live with the condition. Many people with Parkinson’s are diagnosed in a very active phase of their life in their 40’s and their 50’s, they’re still working.

Carers often have to give up their work to care for people with Parkinson’s and the other problem is there is inevitable progression of Parkinson’s because there is age-related dopamine loss that we see so it is a growing problem, we need to have better technology and better assessment to improve our care the area where the care needs to be improved the most is the chronic care at home and in the communities and any artificial intelligence enabled device that gives, allows us to do that, this in an easy user friendly manner is what we need.

There is the visible part of Parkinson’s, which is often the tremor or the stiffness but also the invisible part, what I call the hidden face of Parkinson’s, which includes many non-motor problems such as pains, such as depression, anxiety, social inability, isolation, but also balance issues. So to monitor these, all these problems within the context of a short clinic that we can often offer, either in the NHS or the private sector, is often not possible, so we often rely on people’s own recollection of events in the clinic and/or diaries which can be inaccurate, can be retrospectively completed and the advent of artificial intelligence based technologies to monitor patients better, particularly at home, is therefore a crucial unmet need which is now gradually being bridged. The need for this really was highlighted during the COVID pandemic when the home care and home assessment became of great importance and subsequently it has now been underpinned by NHS initiatives, for instance the so-called ‘virtual wards’ is based on the whole premise that we should be able to monitor people’s condition changes from time-to-time at home and really management of that gives somebody a real hold on their clinical improvement and their quality of life and the PDMonitor provides us with that.

I think Parkinson’s is a condition, that can change from time, from hour to hour. And this is very important for Clinicians, for healthcare professionals who are looking after people with Parkinson’s to recognise, otherwise you might end up managing the people in an inappropriate manner, I’m not saying that virtual technology will replace face-to-face examination, however, face-to-face examination or clinic consultations are fraught with problems which again, several of my colleagues from Netherlands, from the US have called the ‘White Coat Effect’, in other words, patients might either put on their best behaviour when they’re in clinic, they might be excessively stressed, so suddenly a tremor might break through and you might be tempted to treat those symptoms which you see. However when the patient leaves the clinic, when they go back to their carpark or when they drive home, the situation is completely different, are often very different but you’re not seeing that. What you’re then relying on, often, is what the carer or the patient is telling you, which can be very inaccurate because we know that recall in Parkinson’s can be affected. So this device therefore gives us this granular insight into what’s going on at home, which is really after all what matters and allows us treatment strategies which can then influence this treatment and management of people with Parkinson’s at home.

PD Neurotechnology Ltd is a high-tech medical device company, founded in London, UK in 2015, by a team of experts in patient monitoring systems for movement disorders. R&D, production, clinical studies, distribution and customer support is based in Ioannina, Greece, and sales & marketing in Athens, Greece. Its first product, PDMonitor® is a medical device that supports the continuous, objective, remote monitoring of Parkinson’s disease patients and enables a paradigm shift in the management of the disease.

PD Neurotechnology is a Medical Device Company, it was founded in 2015 in the UK it’s operations are run out of Greece, especially Ioannina, which is the North-West of the country and in Athens, and it is now in sales in a number of countries all over Europe. Its first product is called PDMonitor which is a medical device for continuous objective monitoring of Parkinson’s disease.

So PD Neurotechnology is a young medical device company and the first years of its growth had to do with getting a number of certifications in place in order to be able to be called a Medical Device Company. So in its growth trajectory it is now certified with ISO 13485 for being a Medical Device Company, ISO 27001 for the data management, data security and handling of sensitive patient information, and ISO 27701 with regards to GDPR compliance and things around patient privacy. Also it is a vertical integrated company with R&D, production, clinical studies, regulatory distribution, sales and marketing, all run under the same roof and in this trajectory, in this course of life it has developed its first commercially ready product called PDMonitor, which is a CE marked product since June 2019. It is in the market since September 2020 and within the pandemic situation it still has managed to be used by more than 500 patients either in sales or in studies out of 13 countries. There’s a big pipeline of other products in progress and also a pipeline of sub-specifications and sub-indications of PDMonitor in specific aspects and all this reflects the product pipeline of this company.

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