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Symposium Report Safinamide as a Valuable Add-on Therapy – Exploring New Approaches to Parkinson’s Disease Management Through Patient Case Presentations Highlights of a Zambon-sponsored symposium held at the 3rd Congress of the European Academy of Neurology (EAN) – Monday 26 June 2017, in Amsterdam, The Netherlands Expert review by: Alain Kaelin, 1 Jaime Kulisevsky, 2 Heinz Reichmann, 3 Fabrizio Stocchi 4 1. Neurocenter of Southern Switzerland, Manno, Switzerland; 2. Movement Disorders Unit, Neurology Department, Sant Pau Hospital, Autonomous University of Barcelona, CIBERNED and Universitat Oberta de Catalunya, Barcelona, Spain; 3. Technische Universitaet Dresden, Germany; 4. Department of Neurology, University and Institute for Research and Medical Care (IRCCS), San Raffaele, Rome, Italy D opamine replacement is the mainstay of therapy in the early stages of Parkinson’s disease (PD). Over time, however, the motor response to levodopa gradually shortens and motor complications (motor fluctuations and dyskinesias) emerge. There is, therefore, a need for adjunctive therapies to provide control of motor symptoms and to relieve motor complications when they arise. Since the risk of developing motor complications is strongly linked to levodopa dose, there is also a rationale for the early use of adjunctive therapies, in combination with low-dose levodopa, to preserve the efficacy of levodopa for as long as possible. Beyond the cardinal motor symptoms, PD is associated with a diverse range of non-motor symptoms, which may negatively impact patients’ quality of life to a similar or greater extent as the motor symptoms. Patients with PD show alterations in multiple neurotransmitter systems in the brain, and non-dopaminergic pathways are likely to be particularly important in driving non-motor aspects of the disease. Safinamide is a unique therapeutic option in PD, with multiple mechanisms of action including monoamine oxidase-B and dopamine reuptake inhibition, activity-dependent sodium-channel inhibition, and inhibition of abnormal glutamate release. Safinamide has been shown to be effective as an add-on to levodopa in patients with mid- to late-stage PD, prolonging levodopa efficacy, improving motor function and increasing ON time with no/non-troublesome dyskinesia. Safinamide has been investigated in short- and long-term (24-month) studies and has demonstrated a very good safety profile together with long-term efficacy. Emerging data indicate that safinamide may also have promising benefits in non-motor Parkinson’s symptoms such as pain and mood disturbances. This report uses patient cases to illustrate the range of patients with PD who may benefit from the addition of safinamide to existing levodopa therapy. They include patients who require better control of motor and/or non-motor symptoms and patients who are experiencing motor complications (fluctuations and dyskinesias) in response to levodopa. Keywords Safinamide, add-on, motor complications, wearing-off, levodopa-induced dyskinesia, dopaminergic, glutamatergic, levodopa adjunct, motor symptoms Disclosure: Alain Kaelin received financial support from Zambon for the participation in this symposium and advisory board, and has received unrestricted research grants from Merz and AbbVie. Jaime Kulisevsky is on scientific advisory boards for Zambon, Bial, AbbVie, Prexton, Acorda and Roche and has received speaker honoraria support from Zambon, UCB, Teva and AbbVie. Heinz Reichmann has received speaker honoraria and is an advisory board member for Bayer Healthcare, Bial, Boehringer Ingelheim, Desitin, Pfizer, Lundbeck, Merck, Teva, GlaxoSmithKline, UCB, Novartis, Valeant, Solvay, and Zambon; and has received research grants from Bayer Healthcare, Boehringer Ingelheim, Pfizer, Lundbeck, Teva, GlaxoSmithKline, UCB. Fabrizio Stocchi is on scientific advisory boards for Sunovion Pharmaceuticals Inc., Teva, Novartis, GSK, Lundbeck, IMPAX, Serono, MSD, UCB and Chiesi Pharmaceutical; has received honoraria from Sunovion CNS Canada Development ULC; has received research support from Novartis and GSK; and is a consultant speaking on behalf of Sunovion Pharmaceuticals Inc. This article reports the proceedings of a sponsored satellite symposium held at the 3rd Congress of the European Academy of Neurology (EAN) 2017 and, as such, has not been subject to this journal’s usual peer-review process. The report was reviewed for scientific accuracy by the symposium speakers and a member of the editorial board before publication. Acknowledgements: Editorial assistance was provided by IntraMed Communications s.r.l., funded by Zambon SpA. Compliance with Ethics: Unless otherwise stated, written informed consent was obtained from the patient cases included in this report. Authorship: All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship of this manuscript, take responsibility for the integrity of the work as a whole, and have given final approval for the version to be published. Open Access: This article is published under the Creative Commons Attribution Noncommercial License, which permits any non-commercial use, distribution, adaptation and reproduction provided the original author(s) and source are given appropriate credit. Received: 24 October 2017 Published Online: 28 November 2017 Citation: European Neurological Review, 2017;12(Suppl. 6):3–10 Corresponding Author: Fabrizio Stocchi, Department of Neurology, University and Institute for Research and Medical Care (IRCCS), San Raffaele, Rome, Italy. E: Support: This article was drafted from a symposium sponsored by Zambon SpA. The publication of this article was supported by Zambon SpA. The views and opinions expressed are those of the authors and not necessarily those of Zambon SpA. TOUC H MED ICA L MEDIA 3