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Clinical and neuropsychological follow up at 12 months in patients with complicated Parkinson's disease treated with subcutaneous apomorphine infusion or deep brain stimulation of the subthalamic nucleus.
J Neurol Neurosurg Psychiatry. 2006 Apr; 77(4):450-3.JN

Abstract

BACKGROUND

The clinical condition of advanced Parkinson's disease (PD) patients is often complicated by motor fluctuations and dyskinesias which are difficult to control with available oral medications.

OBJECTIVE

To compare clinical and neuropsychological 12 month outcome following subcutaneous apomorphine infusion (APO) and chronic deep brain stimulation of the subthalamic nucleus (STN-DBS) in advanced PD patients.

METHODS

Patients with advanced PD and medically untreatable fluctuations underwent either APO (13 patients) or STN-DBS (12 patients). All patients were clinically (UPDRS-III, AIMS, 12 h on-off daily) and neuropsychologically (MMSE, Hamilton-17 depression, NPI) evaluated at baseline and at 12 months. APO was discontinued at night.

RESULTS

At 12 months APO treatment (74.78+/-24.42 mg/day) resulted in significant reduction in off time (-51%) and no change in AIMS. Levodopa equivalent medication doses were reduced from 665.98+/-215 mg/day at baseline to 470+/-229 mg/day. MMSE, NPI, and Hamilton depression scores were unchanged. At 12 months STN-DBS resulted in significant clinical improvement in terms of reduction in daily off time (-76%) and AIMS (-81%) as well as levodopa equivalent medication doses (980+/-835 to 374+/-284 mg/day). Four out of 12 patients had stopped oral medications. MMSE was unchanged (from 28.6+/-0.3 to 28.4+/-0.6). Hamilton depression was also unchanged, but NPI showed significant worsening (from 6.58+/-9.8 to 18.16+/-10.2; p<0.02). Category fluency also declined.

CONCLUSIONS

Both APO and STN-DBS resulted in significant clinical improvement in complicated PD. STN-DBS resulted in greater reduction in dopaminergic medications and provided 24 h motor benefit. However, STN-DBS, unlike APO, appears to be associated with significant worsening on NPI resulting from long term behavioral problems in some patients.

Authors+Show Affiliations

Centro Parkinson, Istituti Clinici di Pefezionamento, 20126 Milan, Italy.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

16543520

Citation

De Gaspari, D, et al. "Clinical and Neuropsychological Follow Up at 12 Months in Patients With Complicated Parkinson's Disease Treated With Subcutaneous Apomorphine Infusion or Deep Brain Stimulation of the Subthalamic Nucleus." Journal of Neurology, Neurosurgery, and Psychiatry, vol. 77, no. 4, 2006, pp. 450-3.
De Gaspari D, Siri C, Landi A, et al. Clinical and neuropsychological follow up at 12 months in patients with complicated Parkinson's disease treated with subcutaneous apomorphine infusion or deep brain stimulation of the subthalamic nucleus. J Neurol Neurosurg Psychiatry. 2006;77(4):450-3.
De Gaspari, D., Siri, C., Landi, A., Cilia, R., Bonetti, A., Natuzzi, F., Morgante, L., Mariani, C. B., Sganzerla, E., Pezzoli, G., & Antonini, A. (2006). Clinical and neuropsychological follow up at 12 months in patients with complicated Parkinson's disease treated with subcutaneous apomorphine infusion or deep brain stimulation of the subthalamic nucleus. Journal of Neurology, Neurosurgery, and Psychiatry, 77(4), 450-3.
De Gaspari D, et al. Clinical and Neuropsychological Follow Up at 12 Months in Patients With Complicated Parkinson's Disease Treated With Subcutaneous Apomorphine Infusion or Deep Brain Stimulation of the Subthalamic Nucleus. J Neurol Neurosurg Psychiatry. 2006;77(4):450-3. PubMed PMID: 16543520.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Clinical and neuropsychological follow up at 12 months in patients with complicated Parkinson's disease treated with subcutaneous apomorphine infusion or deep brain stimulation of the subthalamic nucleus. AU - De Gaspari,D, AU - Siri,C, AU - Landi,A, AU - Cilia,R, AU - Bonetti,A, AU - Natuzzi,F, AU - Morgante,L, AU - Mariani,C B, AU - Sganzerla,E, AU - Pezzoli,G, AU - Antonini,A, PY - 2006/3/18/pubmed PY - 2006/5/19/medline PY - 2006/3/18/entrez SP - 450 EP - 3 JF - Journal of neurology, neurosurgery, and psychiatry JO - J Neurol Neurosurg Psychiatry VL - 77 IS - 4 N2 - BACKGROUND: The clinical condition of advanced Parkinson's disease (PD) patients is often complicated by motor fluctuations and dyskinesias which are difficult to control with available oral medications. OBJECTIVE: To compare clinical and neuropsychological 12 month outcome following subcutaneous apomorphine infusion (APO) and chronic deep brain stimulation of the subthalamic nucleus (STN-DBS) in advanced PD patients. METHODS: Patients with advanced PD and medically untreatable fluctuations underwent either APO (13 patients) or STN-DBS (12 patients). All patients were clinically (UPDRS-III, AIMS, 12 h on-off daily) and neuropsychologically (MMSE, Hamilton-17 depression, NPI) evaluated at baseline and at 12 months. APO was discontinued at night. RESULTS: At 12 months APO treatment (74.78+/-24.42 mg/day) resulted in significant reduction in off time (-51%) and no change in AIMS. Levodopa equivalent medication doses were reduced from 665.98+/-215 mg/day at baseline to 470+/-229 mg/day. MMSE, NPI, and Hamilton depression scores were unchanged. At 12 months STN-DBS resulted in significant clinical improvement in terms of reduction in daily off time (-76%) and AIMS (-81%) as well as levodopa equivalent medication doses (980+/-835 to 374+/-284 mg/day). Four out of 12 patients had stopped oral medications. MMSE was unchanged (from 28.6+/-0.3 to 28.4+/-0.6). Hamilton depression was also unchanged, but NPI showed significant worsening (from 6.58+/-9.8 to 18.16+/-10.2; p<0.02). Category fluency also declined. CONCLUSIONS: Both APO and STN-DBS resulted in significant clinical improvement in complicated PD. STN-DBS resulted in greater reduction in dopaminergic medications and provided 24 h motor benefit. However, STN-DBS, unlike APO, appears to be associated with significant worsening on NPI resulting from long term behavioral problems in some patients. SN - 0022-3050 UR - https://www.unboundmedicine.com/medline/citation/16543520/Clinical_and_neuropsychological_follow_up_at_12_months_in_patients_with_complicated_Parkinson's_disease_treated_with_subcutaneous_apomorphine_infusion_or_deep_brain_stimulation_of_the_subthalamic_nucleus_ L2 - https://jnnp.bmj.com/lookup/pmidlookup?view=long&amp;pmid=16543520 DB - PRIME DP - Unbound Medicine ER -