Platform-Based Balance Assessment in Parkinson's Disease: A Summary of Tasks and Parameters: A Systematic Review

Presenter: C. Georgiou

This systematic review evaluated the use of force platforms (FPs) for assessing postural instability (PI) in patients with Parkinson's disease (PD). The review aimed to identify the force platform-based balance tests used in clinical studies and summarize the most commonly reported force platform parameters. Studies published in Scopus, PubMed, and Embase up to September 2025 were screened. Of 3,204 articles identified, 113 met the inclusion criteria after eligibility assessment. Study quality was evaluated using the Joanna Briggs Institute (JBI) Critical Appraisal Tools. The included studies assessed a total of 3,121 patients with idiopathic Parkinson's disease. Most studies evaluated static balance by having patients stand with their feet apart on a force platform under eyes open or eyes closed conditions, either on a stable surface or a compliant surface. Dynamic balance was assessed in a smaller number of studies. The most commonly reported force platform-derived parameters were centre of pressure (CoP) displacement, CoP velocity, CoP path length, and the area encompassing all centre of pressure points (total area) or 95% of centre of pressure points (ellipse area).

Overall, the review suggests that force platforms are valuable tools for objectively assessing balance in Parkinson's disease. The authors also highlight the need for further research to determine their role in detecting subclinical postural instability during early disease, monitoring disease progression, and evaluating balance rehabilitation.

Efficacy of Opicapone in Early Motor Fluctuations in Parkinson's Disease: A Comparison of Early Versus Later Initiation

Presenter: J. Ferreira

This post-hoc (after the study) analysis evaluated the long-term effects of early initiation of opicapone in levodopa-treated patients with Parkinson's disease (PD) who had developed wearing-off within 2 years before study entry. Patients recorded their ON and OFF periods (times when their medication was working well versus times when symptoms returned) using 24-hour diaries. Data were pooled from randomized, 3.5-month, double-blind, placebo-controlled studies and their 1-year open-label extension. Participants initially received either opicapone 50 mg or placebo, and all continued opicapone during the extension phase. Patients recorded their ON and OFF periods (times when their medication was working well versus times when symptoms returned) using 24-hour diaries. The analysis included 227 patients with recent-onset wearing-off, comprising 117 who received opicapone and 110 who received placebo during the double-blind phase. At the end of the double-blind phase, opicapone 50 mg significantly reduced OFF-time compared with placebo, with a placebo-adjusted reduction of 65.6 minutes (95% confidence interval [CI], −105.5 to −25.6 minutes; p = 0.0014). It also significantly increased Good-ON-time by 88.3 minutes (95% CI, 47.0–129.6 minutes; p < 0.0001). After the 1-year open-label extension, patients who started opicapone earlier maintained numerically greater reductions in OFF-time (−30.0 minutes; 95% CI, −74.8 to 14.8; p = 0.20) and greater increases in Good-ON-time (+38.2 minutes; 95% CI, −6.6 to 82.9; p = 0.09) than those who started opicapone later. Throughout the study, mean levodopa doses remained stable in both groups, and there was no significant increase in ON-time with troublesome dyskinesia.

Early opicapone provided sustained improvements of approximately 2.5 hours in OFF-time and Good-ON time.

Levodopa Dose-Related Risk of Motor Complications in Early Parkinson's Disease Patients Treated with Opicapone: Findings from EPSILON Study

Presenter: J. Ferreira

This post-hoc (after the study) analysis of the Early ParkinSon wIth L-DOPA/DDCI and OpicapoNe (EPSILON) study evaluated whether baseline levodopa dose and the timing of opicapone (OPC) initiation affected the risk of developing motor complications (MCs) over 1.5 years in patients with Parkinson's disease (PD). The EPSILON study consisted of a 24-week randomized, double-blind, placebo-controlled phase followed by a 1-year open-label extension. Levodopa-treated patients without motor complications received opicapone 50 mg or placebo during the double-blind phase, after which all patients received opicapone. Patients were grouped according to whether they started opicapone during the double-blind phase (OPC-OPC) or after placebo in the open-label extension (PLC-OPC), and were further stratified by baseline levodopa dose (<400 mg/day or ≥400 mg/day). Patients receiving higher levodopa doses (≥400 mg/day) showed a trend toward a greater risk of developing motor complications, particularly when opicapone was started later. The proportion of patients who remained free of motor complications was 81.9% in the OPC-OPC group receiving <400 mg/day of levodopa and 79.0% in those receiving ≥400 mg/day. In comparison, the corresponding proportions in the PLC-OPC group were 73.3% and 66.7%, respectively (p = 0.04). A similar trend was observed for dyskinesia (p = 0.06). The proportion of patients remaining free of OFF episodes was slightly higher in the OPC-OPC group, but this was not influenced by levodopa dose (p = 0.4). OFF dystonia remained uncommon across all treatment groups.

Overall, most patients remained free of motor complications during treatment with opicapone. Earlier initiation of opicapone was associated with a trend toward a lower risk of motor complications, particularly in patients receiving higher doses of levodopa.

Safety and Tolerability of Opicapone in Elderly Parkinson's Disease Patients: A Single-Center, Real-Life Retrospective Study

Presenter: P. Lombardo

This retrospective real-world study evaluated the safety and tolerability of opicapone in patients with Parkinson's disease (PwPD), with a particular focus on older adults. Patients treated with opicapone at an outpatient clinic were divided into two age groups based on treatment initiation: 60–75 years and 75 years or older. Clinical characteristics, including Hoehn and Yahr (H&Y) stage, Movement Disorder Society–Unified Parkinson's Disease Rating Scale Part III (MDS-UPDRS III), levodopa equivalent daily dose (LEDD), concomitant therapies, and adverse events, were assessed at baseline and follow-up. No significant differences were observed between the two age groups in disease duration, Hoehn and Yahr stage, or total levodopa equivalent daily dose at baseline or follow-up. Adverse events occurred more frequently in patients aged 75 years or older than in those aged 60–75 years (50% vs 19%; p = 0.02). However, treatment discontinuation rates did not differ significantly between the age groups. Patients who discontinued opicapone had more severe disease, reflected by a higher Hoehn and Yahr stage (p = 0.01) and higher Movement Disorder Society–Unified Parkinson's Disease Rating Scale Part III scores at both baseline (p = 0.02) and follow-up (p = 0.01). They also had a smaller increase in levodopa equivalent daily dose at follow-up (p = 0.001) and were more often female (p = 0.031). A trend toward an association with older age was also reported (p = 0.005).

Overall, the findings suggest that opicapone was better tolerated in younger patients and those with less advanced Parkinson's disease, while older patients experienced adverse events more frequently. However, larger prospective studies are needed to confirm these observations.

Extended-Release Carbidopa-Levodopa (IPX203) Significantly Increases the Duration of “Good ON” Intervals: Interim Real-World Results From the First 100 Patients in ELEVATE-PD

Presenter: S. Isaacson

This interim analysis of the ongoing ELEVATE-PD phase 4, open-label, real-world study evaluated the effect of an extended-release carbidopa-levodopa (ER carbidopa-levodopa ) formulation, on continuous “Good On” intervals and daily motor fluctuations in patients with Parkinson's disease (PD). Patients receiving immediate-release carbidopa/levodopa (IR CD/LD), IR CD/LD plus catechol-O-methyltransferase (COMT) inhibitors, or existing ER carbidopa-levodopa were switched to newer ER carbidopa-levodopa. Following a 5-week dose optimization period and 1 week of stable dosing, outcomes were assessed using patient Parkinson's disease diaries. This interim analysis included 111 patients who completed Day 42 (Visit 4). At baseline, the mean duration of continuous “Good On” intervals across all treatment groups was 2.92 ± 1.38 hours, and the mean number of daily motor fluctuations was 5.86 ± 1.99. After switching to ER carbidopa-levodopa, patients previously receiving IR CD/LD (n = 74) experienced an increase in the mean duration of continuous “Good On” intervals to 6.65 hours, representing an increase of 3.94 hours. Patients switching from IR CD/LD plus COMT inhibitors (n = 9) had an increase to 3.46 hours (+0.99 hours), while those switching from existing ER carbidopa-levodopa (n = 22) increased to 6.58 hours (+3.09 hours). The mean number of daily motor fluctuations also decreased after switching to ER carbidopa-levodopa. In patients previously receiving IR CD/LD, motor fluctuations decreased to 2.96, corresponding to a reduction of 3.25 episodes (52.85%). In those switching from IR CD/LD plus COMT inhibitors, motor fluctuations decreased to 5.15, a reduction of 1.11 episodes (17.73%). Patients switching from existing ER carbidopa-levodopa experienced a decrease to 2.79, representing a reduction of 1.92 episodes (40.42%).

Overall, switching to ER carbidopa-levodopa was associated with longer continuous “Good On” intervals and fewer daily motor fluctuations, which may improve the predictability of symptom control in patients with Parkinson's disease.

Change in Functional Impact of Dyskinesias and Motor Fluctuations with Foslevodopa/ Foscarbidopa in Parkinson's Disease

Presenter: E. Freire-Álvarez

This post hoc (after the study) analysis evaluated the effect of continuous subcutaneous foslevodopa/foscarbidopa (LDp/CDp) infusion on the functional impact of dyskinesias and motor fluctuations in adults with advanced Parkinson's disease (aPD). Data were analyzed from two phase 3 clinical trials: a 12-week, randomized, double-blind trial comparing LDp/CDp with oral levodopa/carbidopa (LD/CD), and a 52-week open-label safety trial of LDp/CDp. Functional outcomes were assessed using items 4.2 (functional impact of dyskinesias) and 4.4 (functional impact of motor fluctuations) of the Movement Disorder Society–Unified Parkinson's Disease Rating Scale (MDS-UPDRS). In the 12-week randomized trial, the functional impact of dyskinesias worsened significantly in patients receiving oral levodopa/carbidopa (mean change 0.2, standard deviation [SD] 0.7; p = 0.045), whereas it improved significantly in those receiving foslevodopa/foscarbidopa (mean change −0.5, SD 1.0; p = 0.003). The difference between treatment groups was significant (p = 0.001). In the 52-week open-label study, improvement in the functional impact of dyskinesias with foslevodopa/foscarbidopa was maintained, with a mean change of −0.6 (SD 1.1; p ≤ 0.001). The functional impact of motor fluctuations did not change significantly with oral levodopa/carbidopa during the randomized trial (p = 0.344), but improved significantly with foslevodopa/foscarbidopa (mean change −1.0, SD 1.3; p ≤ 0.001), with a significant difference between treatment groups (p = 0.003). This improvement was sustained through 52 weeks, with a mean change of −1.2 (SD 1.4; p ≤ 0.001).

Overall, continuous foslevodopa/foscarbidopa infusion improved the functional impact of both dyskinesias and motor fluctuations, with benefits maintained for up to 52 weeks.

EAN 2026; June 27-30, Geneva, Switzerland.