Remote titration system for a patient with Parkinson's disease

Description

[0001] The invention relates to a titration system, i.e. for searching and modifying the dose, remotely for a patient with Parkinson's disease, i.e. a Parkinson's patient, treated at home by administering an antiparkinsonian drug by means of an infusion pump, in particular apomorphine or a carbidopa / levodopa mixture, or any other molecule.

[0002] Parkinson's disease is a chronic neurological disease characterized by the destruction of dopamine neurons present in the brains of individuals with this disease, called Parkinson's patients.

[0003] Dopamine neurons are involved in controlling body movements, and their destruction leads to various symptoms in Parkinson's patients, such as tremors, muscle stiffness, slowness of movement, more or less significant involuntary movements called dyskinesias, muscle rigidity, postural instability, and freezing (or Freezing Phase Off in English)...

[0004] Often, one of these symptoms is predominant in a given patient; that is, it is the most bothersome symptom for that patient and therefore must be treated as a priority. It can be called the "priority symptom" or the "efficacy criterion."

[0005] To treat Parkinson's disease, patients are given various medications, including dopaminergic drugs, which stimulate dopamine neurons.

[0006] However, it has been noted that this type of drug, particularly oral L-Dopa, exhibits fluctuations in effectiveness in some Parkinson's patients.

[0007] Therefore, in Parkinson's patients with such fluctuations in efficacy and / or in the case of severe dyskinesias, it is recommended to use other antiparkinsonian drugs in liquid form, such as apomorphine or a levodopa / carbidopa mixture, which are stimulators of postsynaptic dopaminergic receptors thus exerting an antiparkinsonian action.

[0008] Liquid antiparkinsonian drugs, for example apomorphine, L-Dopa or levodopa / carbidopa, are usually administered to the patient by means of an infusion pump delivering doses of antiparkinsonian drug during the day and / or night to the patient, via a subcutaneously implanted catheter and / or including the placement of an external transabdominal tube or an internal intestinal tube in the patient.

[0009] It is essential, in order to obtain fully effective treatment for a Parkinson's patient, to be able to deliver the correct dose of medication, in particular apomorphine, throughout the day, that is to say the most effective dose to treat (at least) one priority symptom of Parkinson's disease which most affects or bothers the patient in question.

[0010] However, each patient reacts differently to treatment, and the priority symptom to treat first also varies from one individual to another. Therefore, to determine the most effective dose of medication to treat a patient's priority symptom, the physician must titrate the antiparkinsonian drug being administered to that patient, for example, apomorphine.

[0011] However, Parkinson's patients are generally not hospitalized or their hospitalization period is very short and insufficient to properly define the most effective dose for their symptom(s), given that their treatment usually takes place at home, therefore in the absence of healthcare personnel, i.e. doctor and / or nurse, who can perform the titration used to determine the most effective dose of antiparkinsonian drug for the patient in question.

[0012] Furthermore, it is also desirable to be able to adjust this dose, that is, reduce or increase it, if it is found that the dose set is not effective enough or leads to negative side effects in the patient, such as allergies, hallucinations, behavioral disorders, troublesome dyskinesias, all-day drowsiness, nausea or vomiting under domperidone...

[0013] EP-A-2410448 offers an infusion pump system with a pump controlled based on answers to questions asked of the patient in whom the pump is implanted.

[0014] The problem is therefore to be able to perform remote titration (i.e., research and modification of the dose of antiparkinsonian drug) of a patient with Parkinson's disease who is outside of a hospital, particularly at home, and who is undergoing treatment by infusion of a drug against Parkinson's disease, i.e. an antiparkinsonian drug, such as apomorphine, L-Dopa or a levodopa / carbidopa mixture, such as duodopa ®< , or analogue, which is injected by means of an infusion pump in order to be able to determine the most effective dose of antiparkinsonian drug in the patient in question with respect to a priority symptom, typically the symptom that bothers this patient the most, and taking into account possible adverse effects that may appear during the titration, in order to be able to act on the infusion pump and thus improve the effectiveness of the treatment of the patient in question.

[0015] The solution of the invention relates to a remote titration system for a patient with Parkinson's disease, i.e., a Parkinson's patient treated outside of a hospital, typically at home, comprising: a first device comprising a first HMI (i.e., human-machine interface) including: first input means allowing a first user, such as healthcare personnel, in particular a doctor, to enter titration data including at least: ▪ a plurality of different doses of an antiparkinsonian drug to be administered to a patient by means of an infusion pump, and ▪ daily administration times of said doses of antiparkinsonian drug to said patient by means of an infusion pump, and first display means configured to display at least the plurality of doses of antiparkinsonian drug and the daily administration times entered by means of the first input means, each dose of antiparkinsonian drug being displayed associated with a daily administration time,a second device located at a distance from the first device and comprising a second HMI including: second input means allowing a second user, such as healthcare personnel, for example a home nurse, to enter assessments of at least one pre-defined efficacy criterion for the plurality of doses of antiparkinsonian drug administered by means of said infusion pump, and second display means configured to display the assessments entered by the second user, each assessment of said at least one efficacy criterion being displayed associated with a dose of antiparkinsonian drug, telecommunication means configured to exchange data between the first and second devices, at least one computer server located at a distance from said first and second devices,said computer server: ▪ being configured to process the data entered by means of the first and second devices in such a way as to determine the most effective dose of antiparkinsonian drug for the patient in question from the plurality of different doses of antiparkinsonian drug from the first device and the assessments from the second device, and ▪ cooperating with the telecommunications means to transmit to the first device at least the most effective dose of antiparkinsonian drug for the patient in question having been determined, , and wherein the first and / or second means of display are configured to display at least the most effective dose of antiparkinsonian drug for the patient in question to be administered by means of said infusion pump.

[0016] Depending on the embodiment considered, the remote titration system of the invention may include one or more of the following features: The first and / or second display means are configured to display at least the most effective dose of antiparkinsonian medication for the patient in question, as provided by the telecommunication means. The first input means allow for the entry of antiparkinsonian medication doses between 0.1 and 12 mg / h, preferably between 0.5 and 5 mg / h. Antiparkinsonian medication doses are expressed as the flow rate of the administration pump used to administer / inject the medication, preferably a flow rate between 0 and 8 ml / h or between 0 and 40 mg / h (for a concentration of 5 mg / ml). The first input means allow for the entry of increasing doses of antiparkinsonian medication.The initial data entry methods allow for the entry of doses of apomorphine, L-Dopa, or levodopa / carbidopa mixtures, such as Duodopa®. These methods are also configured to allow the first user, such as a healthcare professional (e.g., a neurologist), to select a maximum dose not to be exceeded for the patient in question. The initial data entry methods allow for the entry of daily administration times per entry for each dose of antiparkinsonian medication: ▪ a start time and an end time for administration, or ▪ a start time and an administration time from that start time. The initial data entry methods also allow for the entry of a given number of days to find an effective dose for a given patient.The second set of input methods allows for the entry of assessments of at least one predefined efficacy criterion for multiple doses of antiparkinsonian medication as a numerical value, specifically expressed as a percentage (%), for example, a percentage improvement. The first set of input methods is configured to allow the first user, such as a healthcare professional, particularly a neurologist, to select or choose the efficacy criterion. The first set of input methods is configured to allow the first user to select or choose an efficacy criterion from among several stored or predefined efficacy criteria. The first set of input methods is configured to allow the first user to select or enter a level of efficacy for said efficacy criterion, for example, a percentage of efficacy.The initial data entry methods are configured to allow modification, adjustment, or adaptation of one or more doses of antiparkinsonian medication to be administered to the patient, particularly in response to the occurrence of one or more adverse effects. Indeed, during the titration phase, adverse effects may appear, such as allergies (excluding nodules), confusion, hallucinations, behavioral disturbances, troublesome dyskinesias, all-day sleepiness, symptomatic hypotension, nausea / vomiting while taking domperidone or other medications. These must be monitored and may impact the titration phase. Medication doses, particularly apomorphine, are then preferentially adjusted based on their occurrence. The initial data entry methods are configured to allow entry or selection of at least one adverse effect, preferably from a list of several adverse effects, such as a pre-recorded list.The first input methods are configured to allow the entry or selection of at least one adverse effect and a degree of annoyance for that adverse effect, for example, "annoying" or "slightly annoying." The first input methods are configured to allow the entry or selection of at least one adverse effect chosen from among allergies (excluding nodules), confusion, hallucinations, behavioral disturbances, troublesome dyskinesias, all-day sleepiness, symptomatic hypotension, nausea or vomiting under domperidone, or others. The first display methods are configured to display one or more adverse effects, preferably a list of several adverse effects, for example, a pre-recorded list.The first display means are configured to show a selected adverse effect from among several adverse effects and optionally the degree of discomfort associated with said adverse effect. The first display means are configured to show a treatment adjustment instruction in response to the presence of at least one adverse effect; preferably, the treatment adjustment instruction is chosen from treatment interruption, maintaining the current drug dose, continuing titration, increasing, or decreasing the drug dose. The second display means are configured to show one or more pieces of information including the current drug dose and optionally the presence of at least one adverse effect and optionally at least one treatment adjustment instruction.The second input methods are configured to allow the entry or selection of a new medication dose based on the presence of at least one adverse effect and, potentially, at least one treatment adjustment instruction. The second display methods are configured to display the entered or selected new medication dose based on the presence of at least one adverse effect and, potentially, at least one treatment adjustment instruction.According to another embodiment of the invention, the computer server is configured to process the data entered by means of the first and second devices in such a way as to determine the most effective dose of antiparkinsonian drug for the patient in question from the plurality of different doses of antiparkinsonian drug from the first device and the assessments from the second device, in relation to the effective dose level set by the nursing staff.The second data entry method allows for the recording of assessments of at least one predefined efficacy criterion for the patient in question, chosen from the following criteria: ▪ improvement in movement freezing, ▪ improvement in freezing duration, ▪ improvement in gait, ▪ reduction in tremors, ▪ reduction in dyskinesias, ▪ reduction in motor fluctuations, ▪ reduction in pain, and ▪ improvement in sleep quality, ▪ or any other criterion that may be established by healthcare personnel, such as a neurologist or similar professional. The efficacy criterion is representative of the treatment of a priority symptom for the patient in question. The efficacy criterion is evaluated in relation to the occurrence of said adverse side effects, for example, allergy, confusion, hallucinations, behavioral disturbances, troublesome dyskinesias, daytime sleepiness, symptomatic hypotension, nausea or vomiting under domperidone or similar medications, etc.The first and second devices are selected from laptops or desktops, tablets, and smartphones. The first display means include a first display screen, and the second display means include a second display screen. The first input means include a numeric keypad, and the second input means include a numeric keypad. The computer server includes one or more processors implementing one or more algorithms, software, programs, or the like. The computer server includes a communication module, such as BLE, Wi-Fi, 2G / 3G / 4G / 5G smart card, or other. The display means include one or more color or monochrome (e.g., black and white) display screens. The display means include a touchscreen.The computer server is configured to determine the most effective dose of antiparkinsonian medication from a plurality of different doses of the same medication and from evaluations of at least one predefined efficacy criterion for each dose. It further includes an infusion pump. The infusion pump is set or controlled to deliver the most effective dose of antiparkinsonian medication to the patient in question. In one embodiment, the infusion pump is controlled, preferably remotely, to deliver the most effective dose of antiparkinsonian medication to the patient in question.The system is configured to deliver an automatic and continuous injection of the antiparkinsonian drug, such as apomorphine, preferably during the day, i.e., between patient P waking and going to bed, or conversely, during the night, i.e., between patient P going to bed and waking up. In another embodiment, the infusion pump is set by the patient or caregivers to the most effective dose of antiparkinsonian drug for that particular patient. The system is configured to deliver a bolus injection of the antiparkinsonian drug, such as apomorphine, by activation of the infusion pump by the patient. The infusion pump includes a reservoir containing the antiparkinsonian drug. The reservoir is a piston reservoir. The reservoir is fluid-connected to a catheter intended for subcutaneous insertion in the patient using a subcutaneous injection needle.The reservoir contains the antiparkinsonian drug in liquid form. The reservoir has a capacity of 100 ml or less, for example, 50 ml or less. The reservoir is removable. The pump includes a memory configured to store all or part of the pump's operating parameters, in particular the dose (i.e., infusion rate value) of the most effective antiparkinsonian drug for the patient in question and / or other parameters such as a daily infusion start time, a daily infusion end time, a maximum number of daily boluses allowed, a bolus volume, or other parameters. The pump includes control means, in particular one (or more) microprocessors, configured to control, directly or indirectly, the supply (i.e., delivery) of the dose (i.e., infusion rate value) of the most effective antiparkinsonian drug for the patient in question, in particular apomorphine.The control means are configured to drive an electric motor that controls the translational movement of an actuation means, such as a pusher or rod, acting on a piston in the reservoir containing the antiparkinsonian drug, so as to push said piston towards a fluid distribution orifice in the reservoir and deliver the desired dose of antiparkinsonian drug. The pump is also equipped with communication means configured to receive data from the first and / or second devices, in particular the most effective dose of antiparkinsonian drug used to modify or adjust the flow rate of the infusion pump. Any suitable communication means can be used, whether wired or wireless, for example, via Wi-Fi, Bluetooth®, or other methods. The pump includes a power source, preferably a battery, advantageously rechargeable.

[0017] The invention also relates to the use of a titration system according to the invention to perform remote titration of a Parkinson's patient, that is to say of a patient with Parkinson's disease, treated at home by administration of an antiparkinsonian drug by means of an infusion pump, in particular apomorphine, carbidopa / levodopa, Duodopa ®< or any other molecule, so as to determine the most effective dose of antiparkinsonian drug in this patient against at least one symptom, in particular a priority symptom, of said Parkinson's disease while preferentially monitoring the appearance of adverse effects.

[0018] The invention will now be better understood through the following detailed description, given by way of illustration but not limitation, with reference to the attached Figures, among which: Fig. 1 Diagram of a Parkinson's patient treated with an anti-Parkinsonian drug infusion. Fig. 2 illustrates a schematic embodiment of a remote titration system for a Parkinson's patient according to the invention, Fig. 3 gives an example of the information displayed by the titration system of the invention, and Fig. 4 à Fig. 8 provide examples of the information displayed by the titration system of the invention in the event of the occurrence or existence of an adverse effect.

[0019] There Fig. 1 This diagram illustrates the administration of an antiparkinsonian drug that stimulates dopamine receptors, such as apomorphine, by infusion in a Parkinson's patient. However, other drugs can be used instead of apomorphine, such as L-Dopa or a carbidopa / levodopa mixture (e.g., Duodopa®). Apomorphine is used as an illustrative but not limiting example.

[0020] As can be seen, the administration of apomorphine (or other medication) is carried out using an infusion pump 101 comprising a piston reservoir 106 connected to a catheter 102 implanted subcutaneously in patient P. The reservoir 106, containing the apomorphine in liquid form, typically has a capacity of a few tens of ml, for example, 20, 30, 50, or 100 ml. Advantageously, the reservoir 106 is removable, meaning that it can be attached to or detached from the rest of the pump 101, notably for replacement or refilling with apomorphine when empty.

[0021] The catheter 102 includes a tube 103 connected to an outlet of the reservoir of the pump 101, used to deliver the apomorphine to a subcutaneous injection needle which allows it to be injected into the patient.

[0022] Preferably, an adhesive or similar system is used to hold the catheter in place on the patient's body. It can be attached to various locations on the body, such as the flanks, shoulder blades, or periumbilical area.

[0023] Such an infusion set allows apomorphine to be injected into patient P either automatically and continuously during the day, or as a bolus by activation of pump 101 by the patient himself, for example in case of excessive tremor requiring the delivery of an additional dose of apomorphine.

[0024] In general, apomorphine (or other medication) injections are given during the day, that is, between the patient's waking and going to bed. However, in some cases, one or more apomorphine administrations may take place during the night.

[0025] The operating parameters of the 101 pump are set by a user, such as a doctor and / or a nurse, i.e. an authorized healthcare professional, at the pump level and stored in a memory integrated into the pump, in particular one (or more) value of infusion rate (i.e. dose of medication), a daily start time of infusion and a daily end time of infusion, and possibly a maximum number of daily boluses allowed and a bolus volume....

[0026] Furthermore, pump 101 also provides control means, such as a microprocessor carried by an electronic card, allowing the supply of apomorphine at the desired flow rate to be controlled directly or indirectly, for example by controlling an electric motor which controls a translational movement of an actuation means, such as a pusher or a rod, acting on the piston of the reservoir in which the apomorphine is contained so as to push back said piston and therefore also the apomorphine (which is pushed by the piston) towards a fluid distribution orifice and thus supplying apomorphine to the tubing of catheter 103.

[0027] The apomorphine pump 101 is preferably inserted into a case 104, a pouch, a small bag or similar which the patient P can for example attach to his belt 105 (as illustrated), worn over the shoulder or hung around his neck.

[0028] Of course, the 101 infusion pump may also include other usual components essential to its operation, such as a power source, for example a battery, preferably rechargeable, a switch on / off device, for example an "on / off" button or key, one or more adjustment or selection keys or buttons, a digital display screen...

[0029] The electrical power source supplies the various components of the pump that require electrical current to operate, in particular the electric motor, control means, including the electronic board and microprocessor, memory...

[0030] There Fig. 2 diagram illustrates an embodiment of a remote titration system, i.e., dose selection system, according to the invention of a Parkinson's patient P, for example the one diagrammed in Fig. 1 , comprising a first device 1 and a second device 2 distant from each other, and communicating 4 via a computer server 3, in particular of the cloud type.

[0031] The first device 1 includes a first HMI 11, 12, i.e. a human-machine interface, comprising first input means 11, such as a numeric or mechanical keyboard, configured to allow a healthcare professional, typically a neurologist M, to enter titration data including different doses D1...Dn, preferably increasing, of antiparkinsonian drug to be administered to patient P, such as apomorphine, and daily administration times of said doses of antiparkinsonian drug to said patient, for example a start time or Td and a finish time or Tf of treatment by infusion via the infusion pump 101.

[0032] The increasing doses D1...Dn of apomorphine are, for example, between 0 and 8 ml / h. Preferably, the doses D are expressed as an apomorphine infusion rate, typically between 0.1 and 5 ml / h. However, they can be expressed in another quantity, for example, mg / h.

[0033] The first display means 12, such as a display screen, are configured to display the plurality of doses D, for example D1 to D5, of antiparkinsonian medication and the daily administration times (i.e., Td and Tf) entered by the physician M, each dose (e.g., D1 to D5) of antiparkinsonian medication being displayed associated with a daily administration time for each day considered (e.g., Day 1 to Day 5), for example, side by side on the display / visualization screen of the first display means 12, as illustrated in Fig. 3 .

[0034] For example, the D1-D5 doses given in Fig. 3 are apomorphine infusion rates of 1, 1.3, 1.5, 1.8 and 2 ml / h, with the start of administration set at 07:00 (Td) and the end at 22:00 of each day (J1-J5).

[0035] The first display means 12 are further configured to display a maximum dose (Dm) chosen by the physician M, namely 2 ml / h. Of course, a higher or lower dose could be chosen.

[0036] The efficacy criterion is generally chosen by the physician M after discussion with the patient P. The pre-set efficacy criterion considered may, for example, be chosen from the following criteria: improvement in movement blocking (i.e. freezing), improvement in blocking duration, improvement in gait, reduction in tremors, reduction in dyskinesias, reduction in motor fluctuations, reduction in pain, and improvement in sleep quality.

[0037] From there, the first input means 11 are also configured to allow the physician M to select an efficacy criterion and to select or enter an effective dose level for said efficacy criterion.

[0038] Furthermore, the second device 2 is located at a distance from the first device 1, typically several hundred meters away, or even several kilometers or tens of kilometers away. It includes a second HMI 21, 22 which also includes second input means 21 and second display means 22, such as a display screen.

[0039] The second input means 21 are configured to allow a patient (P) to enter assessments of one (or more) prefixed efficacy criterion for the plurality of doses D of antiparkinsonian drug, and the second display means 22 are configured to display the assessments entered by patient P, each assessment of the efficacy criterion, for example a % improvement, being displayed associated with a dose of antiparkinsonian drug.

[0040] Preferably, the first device 1 and the second device 2 are chosen from among computers, tablets, and smartphones. For example, the first device 1 is a computer and the second device 2 is a smartphone, as illustrated in Fig. 2 .

[0041] Furthermore, the exchange of information and data between the first and second devices 1, 2 and the computer server 3 takes place via telecommunication means 4, for example transmitter / receiver means and a (or more) telecommunication network, such as the GSM network.

[0042] Preferably, the signal transmission means 4 are configured to transmit remotely via the internet or another communication network, such as GSM, Wi-Fi, LoRa, or Sigfox. For example, they include a GSM 20 or similar modem and a transmitting antenna.

[0043] According to the invention, the computer server 3 is configured to process the data entered by means of the first and second devices 1, 2 so as to determine the most effective dose of antiparkinsonian drug for the patient in question from the plurality of different doses of antiparkinsonian drug from the first device 1 and the evaluations from the second device 2 and cooperates with the telecommunication means 4 to transmit to the first device 1 the most effective dose of antiparkinsonian drug for the patient (P) in question having been determined.

[0044] The most effective dose of antiparkinsonian drug proposed can then be displayed by the first display means 12, and possibly validated afterwards by the doctor M.

[0045] Furthermore, as illustrated on Fig. 4 à Fig. 8 The titration system of the invention can also allow specific information to be displayed in the event of the existence or occurrence of one (or more) adverse effect(s) in the patient.

[0046] Thus, the initial data entry methods 11 are also configured to allow the first user, such as a neurologist, to modify, adjust, or adapt one or more doses of antiparkinsonian medication to be administered to the patient, for example, apomorphine, depending on the appearance of one or more adverse effects. Indeed, during the titration phase, adverse effects may appear in the patient, such as allergies (excluding nodules), confusion, hallucinations, behavioral disturbances, troublesome dyskinesias, all-day sleepiness, symptomatic hypotension, nausea / vomiting while taking domperidone or other medications, which must be monitored and which may impact the titration phase. The medication doses, particularly apomorphine, are then preferentially adjusted based on their occurrence.

[0047] To do this, as illustrated in Fig. 4 , the first display means 12 are then configured to display several selectable adverse effects from a list of several adverse effects, for example a pre-recorded list, namely here a drop-down menu, and the first input means 11 are configured to allow at least one of said adverse effects to be entered.

[0048] Advantageously, the adverse effect can be chosen from a list, like a drop-down menu, including allergies (excluding nodules), confusion, hallucinations, behavioral disturbances, troublesome dyskinesias, all-day sleepiness, symptomatic hypotension, or nausea or vomiting under domperidone.

[0049] Next, the first input means 11 allow the user to enter or select a degree of discomfort (i.e., severity) related to this adverse effect, for example, "bothersome" or "slightly bothersome," and the first display means 12 allow the user to visualize this choice, as illustrated in Fig. 5 .

[0050] As shown schematically in Fig. 6 , the first display means 12 are then configured to display a treatment adjustment instruction in response to the existence of at least one adverse effect, preferably the treatment adjustment instruction is chosen from a treatment interruption, a maintenance of the drug dose, a continuation of titration, an increase or a decrease in the drug dose.

[0051] Advantageously, the first display means 12 can display a summary for the first user, such as a neurologist, of the adverse effect(s) and their degree of discomfort or severity in the patient in question, as schematically represented in Fig. 7 so as to allow him to form an opinion and possibly adjust the doses of medication.

[0052] As illustrated in Fig. 8The first display means 12 are also configured to display one or more pieces of information including the current dose of medication, for example expressed in mg / h (e.g. here 5 mg / h), and possibly the existence of at least one adverse effect and at least one treatment adjustment instruction, and the first input means 11 are, for their part, configured to allow the entry or selection of a new dose of medication based on the existence of the adverse effect and the treatment adjustment instruction displayed on the screen of the first display means 12, and a date from which to apply this new dose.

[0053] In general, the second device 2 also allows for the collection of other information or data, namely not only the operating parameter(s) from the pump 101, such as the infusion rate, but also other information, clinical data, parameters or other data from one (or more) other connected medical device and / or responses to health questionnaires or other, then their analysis and a return of the data to one or more users or stakeholders, such as healthcare personnel, including doctors, nurses or other staff in the hospital or at home.

[0054] In all cases, once the most effective dose of antiparkinsonian drug for the patient in question has been determined, the infusion pump 101 can be set or controlled, preferably remotely, to deliver said dose of antiparkinsonian drug to said patient.

[0055] As explained above, this is done by controlling the perfusion pump 101 by microprocessor-based control means which act on the piston of the perfusion pump 101 in order to deliver the flow rate of antiparkinsonian drug corresponding to the most effective dose of antiparkinsonian drug for the patient in question.

[0056] The control means are preferentially embedded in the perfusion pump 101.

[0057] Advantageously, the pump is also equipped with communication means configured to receive data from the first and / or second devices, in particular the most effective dose of antiparkinsonian drug for the patient in question, which is used to modify or adjust the flow rate of the infusion pump.

[0058] The titration system of the invention therefore makes it possible to search for and modify or adjust, and / or validate, preferably remotely, the most effective dose of drug to be injected into a patient in order to administer a treatment that is as effective as possible, in particular due to taking into account one or more efficacy criteria in the patient concerned.

Claims

1. A remote titration system (10) for a patient (P) suffering from Parkinson's disease, comprising: - a first device (1) comprising a first HMI (11, 12) comprising: • first input means (11) for allowing a first user, in particular a neurologist (M), to enter titration data comprising at least: - a plurality of different doses of an antiparkinsonian drug to be administered to a patient by means of an infusion pump (101), said doses being between 0.1 and 12 mg / h, and - daily administration durations for said doses of antiparkinsonian drug to said patient by means of said infusion pump (101), said daily administration durations comprising: an administration start time and an administration end time, or an administration start time and an administration duration from said administration start time, and • first display means (12) configured to display at least the plurality of doses of antiparkinsonian drug and the daily administration durations entered by means of the first input means (11), each dose of antiparkinsonian drug being displayed associated with a daily administration duration, - a second device (2) located at a distance from the first device (1) and comprising a second HMI (21, 22) comprising: • second input means (21) for allowing a second user to enter evaluations of at least one predefined efficacy criterion for the plurality of doses of antiparkinsonian drug administered by means of said infusion pump (101), • and second display means (22) configured to display the evaluations entered by the second user, each evaluation of said at least one efficacy criterion being displayed associated with a dose of antiparkinsonian drug, - telecommunication means (4) configured to exchange data between the first and second devices (1, 2), and - at least one computer server (3) located at a distance from said first and second devices (1, 2), said computer server (3): %a being configured to process the da first and second devices (1, 2) so as to determine the most effective dose of antiparkinsonian drug for the patient concerned from the plurality of different doses of antiparkinsonian drug originating from the first device (1) and the evaluations originating from the second device (2), and %a cooperating with the telecommunica to the first device (1) at least the most effective dose of antiparkinsonian drug for the patient (P) concerned that has been determined, - and wherein the first and / or second display means (12) are configured to display at least the most effective dose of antiparkinsonian drug for the patient concerned to be administered by means of said infusion pump (101).

2. The titration system according to the preceding claim, characterized in that it further comprises an infusion pump (101) that is adjusted or controlled, preferably remotely, to deliver said most effective dose of antiparkinsonian drug for the patient concerned.

3. The titration system according to any one of the preceding claims, characterized in that the first input means (11) allow for the entry of doses of antiparkinsonian drug between 0.5 and 5 mg / h.

4. The titration system according to any one of the preceding claims, characterized in that the first input means (11) allow for the entry of increasing doses of antiparkinsonian drug.

5. The titration system according to any one of the preceding claims, characterized in that the first input means (11) allow for the entry of doses of apomorphine, L-Dopa, or levodopa / carbidopa, in particular apomorphine.

6. The titration system according to any one of the preceding claims, characterized in that the second input means (21) allow a second user, preferably a patient (P), to enter evaluations of at least one predefined efficacy criterion for the plurality of doses of antiparkinsonian drug in the form of a numerical value, in particular expressed as a percentage (%).

7. The system according to the preceding claim, characterized in that the second input means (21) allow for the entry of evaluations of at least one predefined efficacy criterion for the patient (P) concerned chosen from the following criteria: improvement of movement freezing, improvement of freezing duration, improvement of gait, reduction of tremors, reduction of dyskinesias, reduction of motor fluctuations, reduction of pain, and improvement of sleep quality.

8. The system according to claim 1, characterized in that the first device (1) and the second device (2) are chosen from laptops or desktop computers, digital tablets, and smartphones.

9. The system according to any one of the preceding claims, characterized in that the first input means (11) are configured to allow the first user (M), preferably a neurologist, to select the efficacy criterion and to select or enter an effective dose level for said efficacy criterion.

10. The system according to any one of the preceding claims, characterized in that: - the first input means (11) are configured to allow for the entry or selection of at least one adverse effect and a degree of discomfort of said adverse effect, and - the first display means (12) are configured to allow for the visualization of said at least one adverse effect and said degree of discomfort of said adverse effect.

11. The system according to any one of the preceding claims, characterized in that it further comprises means for allowing the validation of the most effective dose of antiparkinsonian drug that has been determined.

12. The system according to any one of the preceding claims, characterized in that the first display means (12) are further configured to display a treatment adaptation instruction in response to the existence of at least one adverse effect, the treatment adaptation instruction being chosen from an interruption of the treatment, a maintenance of the drug dose, a continuation of the titration, an increase, or a decrease of the drug dose.

13. The system according to any one of the preceding claims, characterized in that the infusion pump (101) comprises a reservoir containing the antiparkinsonian drug and control means configured to command the supply of the most effective dose of antiparkinsonian drug for the patient concerned.

14. The system according to claim 1, characterized in that the first input means (11) are further configured to allow for the entry or selection of a new drug dose based on the existence of the adverse effect and the treatment adaptation instruction displayed on the screen of the first display means (12), and a date from which to apply this new dose.

15. The system according to claim 1, characterized in that the computer server (3) is configured to determine the most effective dose of antiparkinsonian drug from a plurality of different doses of antiparkinsonian drug and evaluations of at least one predefined efficacy criterion for the plurality of doses of antiparkinsonian drug.