Spotlight on our International Parkinson’s Centre of Excellence: Part Two

In the first part of this interview, we heard from Prof K Ray Chaudhuri [pictured below], Director of the National Parkinson Foundation Centre of Excellence at King’s College Hospital and King’s College London, describing King’s Health Partners Neurosciences pioneering research in the field of Parkinson’s disease. In the second part of this interview, Prof K Ray Chaudhuri shares how the Centre’s work fits within the King’s Health Partners’ five-year plan.

The Parkinson Foundation Centre of Excellence at King’s College Hospital and King’s College London (also an affiliated UK Parkinson Excellence Network Centre) offers integrated multidisciplinary clinical and academic services for patients with Parkinson’s disease. The Centre has been successful in the ability to quickly and effectively translate research outcomes into patient care via the global adoption of several outcome tools developed by Prof K Ray Chaudhuri’s team.

Following World Parkinson’s Day on April 11, we spoke with Prof K Ray Chaudhuri for this second of a two-part interview about how the Centre’s pioneering, innovative and historically neglected research into the non-motor symptoms (those unrelated to movement) of Parkinson’s disease fits with our five-year plan.

Prof K Ray Chaudhuri, in part one of your interview you described to us a wide range of King’s Health Partners Neurosciences research, from observing non-motor symptoms in Parkinson’s disease for over a decade to the impact of ethnicity on the natural history of the disease. How do you think your areas of research complement the King’s Health Partners five-year plan?

All the research I have mentioned involves elements of King’s Health Partners five-year plan 'Delivering better health for all through high impact innovation’, for example:

Delivering high impact innovations in novel technologies, therapeutics and diagnostics

• Digitalising measuring motor and non-motor outcomes from Parkinson’s disease via smartphones versus Parkinson's disease: i-PROGNOSIS. This work investigates whether a phone app that monitors movement, mood, and messages could detect the early signs of Parkinson's disease and act as a source of intervention by recommending activities to help maintain functionality and health. The process is designed to provide a bespoke dashboard for patient needs, both motor and non-motor and is engaging to provide triggered clinical pathways.
• We are also leading work in the real-life clinical use of a wearable sensor to detect movement related functions and sleep abnormalities in Parkinson’s disease for use in an UK and European registry with a National Institute for Health Research (NIHR) adopted project now being considered by the National Institute for Health and Care Excellence (NICE). The system provides important home monitoring data on movement as well as sleep in people with Parkinson’s disease.

Transforming quality improvement and outcomes across the system

• We acknowledge the growing importance of Value Based Healthcare and have developed Parkinson’s “outcome scorecards”. Outcome scorecards serve multiple functions but primarily are used to provide an annual update on key outcomes recorded by King’s Health Partners Neurosciences and achievements in education and research. These scorecards also exist as a source of intelligence to open conversations about how and where to prioritise efforts to improve care across the health system.
• We champion the principles of combining motor and non-motor outcomes adopted by Parkinson’s UK, the foremost charity for People with Parkinson’s disease in the UK used now in a national mandatory national audit and also International Committee for Health Outcomes Measurement. Our latest endeavour has yielded the Movement Disorders Society endorsed non-motor scale (MDS-NMS) and the related questionnaire (MDS-NMS-Q) which will hopefully be endorsed by key policymakers in the US Food and Drug Administration and European Medicines Agency for clinical trials in the future.
• We have developed the first ever comprehensive Parkinson's disease service scorecard, with the support of members of our King’s Health Partners Neurosciences Outcomes Working Group. This scorecard will be distributed across the partnership. Its data suggests that 100% of our potential people with Parkinson’s disease were seen within six months of referral and 4% patients were asked about research participation versus 27.6% nationally.

Improving urban population health

• We are using a combined objective scoring system led by the world’s first head-to-head international studies of infusion therapies in Parkinson’s disease (Euroinf study, 2015) and subsequent follow up as Euroinf 2 study (2019) where deep brain stimulation is also added as a comparator. This study was coordinated, conducted and conceptualised by Prof K Ray Chaudhuri’s team at the Parkinson Foundation Centre of Excellence at King’s College Hospital and King’s College London and successfully involved 14 centres across Europe to come together in a world first initiative to compare real life data captured before and after initiation of treatment with advanced therapies in Parkinson’s disease. The work captured real life “head-to-head” comparative motor, non-motor and quality of life data of these three advanced therapies in Parkinson’s disease and has been subsequently used in many countries to support national guidelines as well as by NICE for revised guidelines for Parkinson’s disease (Euroinf study, 2017).
• Our collaboration with deep brain stimulation team led by Prof K Ashkan, Professor of Neurosurgery at King’s College London, and Dr Mike Samuel, consultant neurologist at King’s College Hospital NHS Foundation Trust, and colleagues is also particularly noteworthy and a successful collaboration with the Cologne University has seen more than 10 peer reviewed papers combining 10-12 surgical centres in Europe, Mexico, the USA, and most recently India between 2017-2020.
• We are particularly proud to have pioneered and championed the first recognised expert patient group in Parkinson’s disease in the UK Community for Research Involvement and Support by People with Parkinson’s disease (CRISP PwP). The group is now nationally recognised and meets every two months to suggest and consider research as well as focus on diversity and inclusion. The work is co-ordinated by Neuroscience research manager Alexandra Rizos and supported by Chloe Farrell, a patient advocate and researcher as well as by Ann-Marie Murtagh one of the research directors of the King’s College Hospital NHS Foundation Trust and London South, CRN. A national video made by the group and supported by NIHR London South Clinical Research Network is now widely used to empower patients to take part in research, a key aim of the NHS:

https://www.youtube.com/watch?v=s3RNmfOUdpQ.

In addition, we are one of the first groups to embrace diversity and have a patient ambassador for Parkinson’s disease alliance in Africa. We expect this will foster greater development of Parkinson’s related unmet needs in the African continent as well in the non-white communities in the UK.

Training and developing the healthcare workforce of the future

• Our “group educational evening clinics” for Parkinson’s disease have been led by our Parkinson’s disease specialist nurse as well as other therapy colleagues most notably Miriam Parry, Julia Johnson, speech and language specialist and Shelley Jones, neuro pharmacist and consultant. These unique education orientated group clinics were started by Prof K Ray Chaudhuri and Julia Johnson in 2013 and has grown from strength to strength. The multidisciplinary nature of this group has underpinned its success and its structure and form is notably being replicated elsewhere. More than 50 patients with carers tuned in for the last “virtual” clinic, while a bimonthly Parkinson’s disease nurse led webinar, initiated and supported by the Kings College Hospital NHS Foundation Trust Research and Innovation department and Aleksandra Podlweska, a PhD fellow in the Parkinson’s centre is now bringing together nursing, other allied health specialist colleagues and patients across the UK.
• Our educational footprint is international. We are voted as one of the top five centres for movement disorders training by trainees across the UK and we are affiliated with European Academy of Neurology and Movement Disorders Society training programme. The Centre currently has seven PhD fellows working on non-motor aspects of Parkinson’s and regularly attracts four-fiveinternational visiting fellows and students from all parts of the world.
• We hosted the prestigious “Winter School” for movement disorders supported by the Movement Disorders Society after a competitive process which hosted more than 20 international faculties as well as more than 50 international students. The Centre also led the 200 years celebration of Dr James Parkinson’s original publication of the “An essay on shaking palsy” with an international congress held at the Royal Society in London in March 2017 which attracted over 300 international delegates and hosted 15 international faculties.

Where do you think King’s Health Partners brings the most value for you and your team?

Our focus is people-based research which enables a bench to bedside process in Parkinson’s disease and we are fortunate to have the support of King’s Health Partners which champions translating cutting-edge research into clinical practice. There’s the benefit of bringing together experts in the local campus, nationally and internationally, to devise research that improves the lives of patients living with Parkinson’s disease. Additionally, much of the work we do focuses on developing outcomes to enable Value Based Healthcare. Clinical trials have also played an important part in our work, having already seen implementation of results in clinical practice, making a tangible effect on the lives of people we are here to serve across King’s Health Partners.

We are using our collective expertise to become a global top ten Neurosciences Institute. We deliver outstanding research and education, and drive excellence in care and equity for patients with neurological conditions.