British Movement Disorders Conference 2020

This year’s British Movement Disorders Conference, or ‘BritMODIS 2020’ was held in Birmingham on 31st January. Co-created by the British Geriatrics Society Movement Disorders (BGS-MD) Section and the Parkinson’s Disease Nurse Specialist Association (PDNSA), BritMODIS 2020 was attended by a large group of neurologists, geriatricians, therapists and nurse specialists. It was also live-streamed for those who were unable to attend, and had a strong presence on Twitter via the handle #bgsconf.

The meeting highlighted current clinical practice, provided a platform for presenting new research outcomes and to showcase successful service delivery. This year’s programme covered a range of topics, predominantly pertaining to Parkinson’s disease, and broadly fell into four key areas: palliative care, medication management, specific patient-facing issues, and service transformation.

Parkinson’s nurse specialist Lisa Brown gave a talk on ‘Mortality and institutionalisation after PEG in parkinsonian conditions’ and startled delegates with the data gathered in the local audit she had run. An audit of 83 patients from two institutions over more than a decade found a 30 day mortality of 6%, median survival of 387 days and a rate of institutionalisation of 32%.

She highlighted that many patients who have a PEG are given it during an acute admission, and that one third of these do not have an advanced care plan. She also highlighted that PEG feeding does not always reduce a risk of aspiration, with around a third getting an infection. Her view that survival and complications post-PEG might inform feeding decisions also tied in with the need for better advance care planning, as raised in other speaker sessions.

Fiona Lindop, specialist physiotherapist, discussed the benefits of movement for people with Parkinson’s and ideas for how to encourage more movement without giving off-putting ‘exercise’ advice.

Towards the end of the day, the Parkinson’s Excellence Network launched their 2019 Audit results, highlighting general improvement since 2017, and noting areas of positive practice across the country, as well as areas which need work. One area needing attention, which came up repeatedly in the conference, was end of life planning.

‘Of those people who had markers of advanced Parkinson's (22.3%), discussions regarding end-of-life care issues were recorded in only 36.9% (36.8% in 2017). This raises the question of whether advanced Parkinson’s is sufficiently well recognised, and whether appropriate conversations regarding end-of-life care are started early enough’ (p16 summary report).

Dr Ed Richfield spoke to the conference on palliative care and his views on how we can change this area of care for Parkinson’s, something which he feels so strongly about that he has developed a Palliative Care MasterClass with Neurology Academy. Also speaking on this area of care was nurse specialist Jane Price, who discussed the need for Advanced Care Planning to happen earlier and more naturally, and gave ideas for how to do just that.

Another area noted in the Parkinson’s Audit was ‘driving and excessive daytime sleepiness’, which

‘was recorded in just under three-quarters of cases, as in the previous two audit cycles (72.5% in Elderly Care; 71.1% in Neurology). When excessive daytime sleepiness was recorded, its impact on driving was documented in 67.2% of drivers. This is an increase from 56.6% in 2015 and 62.8% in 2017’ (p16, summary report).

Speaker Dr Katie Lloyd discussed driving and Parkinson’s in one of the first addresses of the day, highlighting that road assessment is the gold standard and that the long term aim is for a means of monitoring road safety in a clinical setting.

In the final session of the day, Dr Iain Wilkinson, consultant orthogeriatrician, asked the conference, said that ‘quality improvement should be part of our daily work.’ He closed by asking delegates: ‘what are you going to do differently tomorrow?’ The answer was undoubtedly, for most, ‘Something.’