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Motor features and response to oral levodopa in patients with Parkinson's disease under continuous dopaminergic infusion or deep brain stimulation.
Eur J Neurol. 2012 Jan; 19(1):76-83.EJ

Abstract

BACKGROUND

Subthalamic nucleus deep brain stimulation (STN DBS) and continuous dopaminergic infusions (jejunal levodopa or subcutaneous apomorphine) are indicated in complicated Parkinson's disease (PD), although it remains unsettled how they compare to each other.

METHODS

We investigated the daytime motor condition in patients with advanced PD under monotherapy with jejunal levodopa, subcutaneous apomorphine, or STN DBS and also measured the motor changes produced by an additional standard morning dose of levodopa. Motor performance was assessed with the UPDRS-III, hand taps, the AIMS dyskinesia score and patients' diaries. Outcome measures were time to best motor 'on' after start of morning treatment, daytime variability of motor condition, motor scores.

RESULTS

The time to 'on' was longest in the jejunal levodopa group. DBS and jejunal levodopa treatments produced stable motor conditions without appreciable 'off' episodes. Continuous apomorphine infusion was associated with the worst motor scores (UPDRS-III and taps) and the most frequent off-states. Jejunal levodopa infusion was associated with the highest AIMS scores. Addition of a levodopa dose produced shortening of time to 'on' and a transient motor improvement in the jejunal levodopa group without increase in dyskinesias; in the DBS and apomorphine groups, there was an increase in dyskinesias without changes in UPDRS-III or taps.

CONCLUSIONS

STN DBS provided adequate trade-off between motor improvement and dyskinesia control, although dyskinesias could be elicited by adding oral levodopa. Jejunal levodopa infusion produced adequate motor improvement with slow time to 'on' and moderate dyskinesias. Apomorphine infusion produced insufficient motor control and negligible dyskinesias.

Authors+Show Affiliations

Istituto Neurologico Carlo Besta, Milan, Italy.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Journal Article

Language

eng

PubMed ID

21645174

Citation

Elia, A E., et al. "Motor Features and Response to Oral Levodopa in Patients With Parkinson's Disease Under Continuous Dopaminergic Infusion or Deep Brain Stimulation." European Journal of Neurology, vol. 19, no. 1, 2012, pp. 76-83.
Elia AE, Dollenz C, Soliveri P, et al. Motor features and response to oral levodopa in patients with Parkinson's disease under continuous dopaminergic infusion or deep brain stimulation. Eur J Neurol. 2012;19(1):76-83.
Elia, A. E., Dollenz, C., Soliveri, P., & Albanese, A. (2012). Motor features and response to oral levodopa in patients with Parkinson's disease under continuous dopaminergic infusion or deep brain stimulation. European Journal of Neurology, 19(1), 76-83. https://doi.org/10.1111/j.1468-1331.2011.03437.x
Elia AE, et al. Motor Features and Response to Oral Levodopa in Patients With Parkinson's Disease Under Continuous Dopaminergic Infusion or Deep Brain Stimulation. Eur J Neurol. 2012;19(1):76-83. PubMed PMID: 21645174.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Motor features and response to oral levodopa in patients with Parkinson's disease under continuous dopaminergic infusion or deep brain stimulation. AU - Elia,A E, AU - Dollenz,C, AU - Soliveri,P, AU - Albanese,A, Y1 - 2011/06/04/ PY - 2011/6/8/entrez PY - 2011/6/8/pubmed PY - 2012/4/7/medline SP - 76 EP - 83 JF - European journal of neurology JO - Eur J Neurol VL - 19 IS - 1 N2 - BACKGROUND: Subthalamic nucleus deep brain stimulation (STN DBS) and continuous dopaminergic infusions (jejunal levodopa or subcutaneous apomorphine) are indicated in complicated Parkinson's disease (PD), although it remains unsettled how they compare to each other. METHODS: We investigated the daytime motor condition in patients with advanced PD under monotherapy with jejunal levodopa, subcutaneous apomorphine, or STN DBS and also measured the motor changes produced by an additional standard morning dose of levodopa. Motor performance was assessed with the UPDRS-III, hand taps, the AIMS dyskinesia score and patients' diaries. Outcome measures were time to best motor 'on' after start of morning treatment, daytime variability of motor condition, motor scores. RESULTS: The time to 'on' was longest in the jejunal levodopa group. DBS and jejunal levodopa treatments produced stable motor conditions without appreciable 'off' episodes. Continuous apomorphine infusion was associated with the worst motor scores (UPDRS-III and taps) and the most frequent off-states. Jejunal levodopa infusion was associated with the highest AIMS scores. Addition of a levodopa dose produced shortening of time to 'on' and a transient motor improvement in the jejunal levodopa group without increase in dyskinesias; in the DBS and apomorphine groups, there was an increase in dyskinesias without changes in UPDRS-III or taps. CONCLUSIONS: STN DBS provided adequate trade-off between motor improvement and dyskinesia control, although dyskinesias could be elicited by adding oral levodopa. Jejunal levodopa infusion produced adequate motor improvement with slow time to 'on' and moderate dyskinesias. Apomorphine infusion produced insufficient motor control and negligible dyskinesias. SN - 1468-1331 UR - https://www.unboundmedicine.com/medline/citation/21645174/Motor_features_and_response_to_oral_levodopa_in_patients_with_Parkinson's_disease_under_continuous_dopaminergic_infusion_or_deep_brain_stimulation_ L2 - https://doi.org/10.1111/j.1468-1331.2011.03437.x DB - PRIME DP - Unbound Medicine ER -