Tags

Type your tag names separated by a space and hit enter

EuroInf 2: Subthalamic stimulation, apomorphine, and levodopa infusion in Parkinson's disease.
Mov Disord. 2019 03; 34(3):353-365.MD

Abstract

OBJECTIVE

Real-life observational report of clinical efficacy of bilateral subthalamic stimulation (STN-DBS), apomorphine (APO), and intrajejunal levodopa infusion (IJLI) on quality of life, motor, and nonmotor symptoms (NMS) in Parkinson's disease (PD).

METHODS

In this prospective, multicenter, international, real-life cohort observation study of 173 PD patients undergoing STN-DBS (n = 101), IJLI (n = 33), or APO (n = 39) were followed-up using PDQuestionnaire-8, NMSScale (NMSS), Unified PD Rating Scale (UPDRS)-III, UPDRS-IV, and levodopa equivalent daily dose (LEDD) before and 6 months after intervention. Outcome changes were analyzed with Wilcoxon signed-rank or paired t test when parametric tests were applicable. Multiple comparisons were corrected (multiple treatments/scales). Effect strengths were quantified with relative changes, effect size, and number needed to treat. Analyses were computed before and after propensity score matching, balancing demographic and clinical characteristics.

RESULTS

In all groups, PDQuestionnaire-8, UPDRS-IV, and NMSS total scores improved significantly at follow-up. Levodopa equivalent daily dose was significantly reduced after STN-DBS. Explorative NMSS domain analyses resulted in distinct profiles: STN-DBS improved urinary/sexual functions, mood/cognition, sleep/fatigue, and the miscellaneous domain. IJLI improved the 3 latter domains and gastrointestinal symptoms. APO improved mood/cognition, perceptual problems/hallucinations, attention/memory, and the miscellaneous domain. Overall, STN-DBS and IJLI seemed favorable for NMSS total score, and APO favorable for neuropsychological/neuropsychiatric NMS and PDQuestionnaire-8 outcome.

CONCLUSIONS

This is the first comparison of quality of life, nonmotor. and motor outcomes in PD patients undergoing STN-DBS, IJLI, and APO in a real-life cohort. Distinct effect profiles were identified for each treatment option. Our results highlight the importance of holistic nonmotor and motor symptoms assessments to personalize treatment choices. © 2019 International Parkinson and Movement Disorder Society.

Authors+Show Affiliations

Department of Neurology, University Hospital Cologne, Cologne, Germany. National Parkinson Foundation International Centre of Excellence, King's College Hospital, London, United Kingdom.National Center of Epidemiology and CIBERNED, Carlos III Institute of Health, Madrid, Spain.National Parkinson Foundation International Centre of Excellence, King's College Hospital, London, United Kingdom.Department of Neurology, University Medical Center Ljubljana, Ljubljana, Slovenia.Department of Neurology, Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil.National Parkinson Foundation International Centre of Excellence, King's College Hospital, London, United Kingdom.National Parkinson Foundation International Centre of Excellence, King's College Hospital, London, United Kingdom. Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.Department of Neurology, University Hospital Cologne, Cologne, Germany.Department of Neurology, University Medical Center Ljubljana, Ljubljana, Slovenia.Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.Department of Neurology, University Hospital Cologne, Cologne, Germany.National Parkinson Foundation International Centre of Excellence, King's College Hospital, London, United Kingdom.Department of Neurology and Neurosurgery, Salford Royal Foundation Trust, Manchester Academic Health Science Centre, University of Manchester, Greater Manchester, United Kingdom.Department of Neurology and Neurosurgery, Salford Royal Foundation Trust, Manchester Academic Health Science Centre, University of Manchester, Greater Manchester, United Kingdom.Department of Neurology, Klinikum-Bremerhaven, Bremerhaven, Germany. Department of Neurology, Skane University Hospital, Lund, Sweden.Department of Neurology, Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil. Laboratory of Neuromodulation, Institute of Teaching and Research, Hospital Sirio-Libanês, São Paulo, Brazil.Department of Neurology, University Hospital Cologne, Cologne, Germany. Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Centre Jülich, Jülich, Germany.Movement Disorder Clinic, University Hospital of Bispebjerg, Copenhagen, Denmark.Movement Disorder Clinic, Kliniken Beelitz, Beelitz-Heilstätten, Germany.Department of Neurology, University Medical Center Ljubljana, Ljubljana, Slovenia.Department of Stereotaxy and Functional Neurosurgery, University Hospital Cologne, Cologne, Germany.Department for Parkinson's disease, IRCCS Hospital San Camillo, Venice, Italy. Department of Neuroscience, University of Padua, Padua, Italy.Department of Neurology, University Hospital Cologne, Cologne, Germany. Department of Neurology, University Hospital Giessen and Marburg, Marburg, Germany.National Parkinson Foundation International Centre of Excellence, King's College Hospital, London, United Kingdom. Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.No affiliation info available

Pub Type(s)

Journal Article
Multicenter Study
Observational Study

Language

eng

PubMed ID

30719763

Citation

Dafsari, Haidar S., et al. "EuroInf 2: Subthalamic Stimulation, Apomorphine, and Levodopa Infusion in Parkinson's Disease." Movement Disorders : Official Journal of the Movement Disorder Society, vol. 34, no. 3, 2019, pp. 353-365.
Dafsari HS, Martinez-Martin P, Rizos A, et al. EuroInf 2: Subthalamic stimulation, apomorphine, and levodopa infusion in Parkinson's disease. Mov Disord. 2019;34(3):353-365.
Dafsari, H. S., Martinez-Martin, P., Rizos, A., Trost, M., Dos Santos Ghilardi, M. G., Reddy, P., Sauerbier, A., Petry-Schmelzer, J. N., Kramberger, M., Borgemeester, R. W. K., Barbe, M. T., Ashkan, K., Silverdale, M., Evans, J., Odin, P., Fonoff, E. T., Fink, G. R., Henriksen, T., Ebersbach, G., ... Ray Chaudhuri, K. (2019). EuroInf 2: Subthalamic stimulation, apomorphine, and levodopa infusion in Parkinson's disease. Movement Disorders : Official Journal of the Movement Disorder Society, 34(3), 353-365. https://doi.org/10.1002/mds.27626
Dafsari HS, et al. EuroInf 2: Subthalamic Stimulation, Apomorphine, and Levodopa Infusion in Parkinson's Disease. Mov Disord. 2019;34(3):353-365. PubMed PMID: 30719763.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - EuroInf 2: Subthalamic stimulation, apomorphine, and levodopa infusion in Parkinson's disease. AU - Dafsari,Haidar S, AU - Martinez-Martin,Pablo, AU - Rizos,Alexandra, AU - Trost,Maja, AU - Dos Santos Ghilardi,Maria Gabriela, AU - Reddy,Prashanth, AU - Sauerbier,Anna, AU - Petry-Schmelzer,Jan Niklas, AU - Kramberger,Milica, AU - Borgemeester,Robbert W K, AU - Barbe,Michael T, AU - Ashkan,Keyoumars, AU - Silverdale,Monty, AU - Evans,Julian, AU - Odin,Per, AU - Fonoff,Erich Talamoni, AU - Fink,Gereon R, AU - Henriksen,Tove, AU - Ebersbach,Georg, AU - Pirtošek,Zvezdan, AU - Visser-Vandewalle,Veerle, AU - Antonini,Angelo, AU - Timmermann,Lars, AU - Ray Chaudhuri,K, AU - ,, Y1 - 2019/02/04/ PY - 2018/06/04/received PY - 2018/12/18/revised PY - 2019/01/04/accepted PY - 2019/2/6/pubmed PY - 2019/12/21/medline PY - 2019/2/6/entrez KW - Apomorphine KW - Deep brain stimulation KW - Intrajejunal levodopa infusion KW - Nonmotor symptoms KW - Quality of life SP - 353 EP - 365 JF - Movement disorders : official journal of the Movement Disorder Society JO - Mov Disord VL - 34 IS - 3 N2 - OBJECTIVE: Real-life observational report of clinical efficacy of bilateral subthalamic stimulation (STN-DBS), apomorphine (APO), and intrajejunal levodopa infusion (IJLI) on quality of life, motor, and nonmotor symptoms (NMS) in Parkinson's disease (PD). METHODS: In this prospective, multicenter, international, real-life cohort observation study of 173 PD patients undergoing STN-DBS (n = 101), IJLI (n = 33), or APO (n = 39) were followed-up using PDQuestionnaire-8, NMSScale (NMSS), Unified PD Rating Scale (UPDRS)-III, UPDRS-IV, and levodopa equivalent daily dose (LEDD) before and 6 months after intervention. Outcome changes were analyzed with Wilcoxon signed-rank or paired t test when parametric tests were applicable. Multiple comparisons were corrected (multiple treatments/scales). Effect strengths were quantified with relative changes, effect size, and number needed to treat. Analyses were computed before and after propensity score matching, balancing demographic and clinical characteristics. RESULTS: In all groups, PDQuestionnaire-8, UPDRS-IV, and NMSS total scores improved significantly at follow-up. Levodopa equivalent daily dose was significantly reduced after STN-DBS. Explorative NMSS domain analyses resulted in distinct profiles: STN-DBS improved urinary/sexual functions, mood/cognition, sleep/fatigue, and the miscellaneous domain. IJLI improved the 3 latter domains and gastrointestinal symptoms. APO improved mood/cognition, perceptual problems/hallucinations, attention/memory, and the miscellaneous domain. Overall, STN-DBS and IJLI seemed favorable for NMSS total score, and APO favorable for neuropsychological/neuropsychiatric NMS and PDQuestionnaire-8 outcome. CONCLUSIONS: This is the first comparison of quality of life, nonmotor. and motor outcomes in PD patients undergoing STN-DBS, IJLI, and APO in a real-life cohort. Distinct effect profiles were identified for each treatment option. Our results highlight the importance of holistic nonmotor and motor symptoms assessments to personalize treatment choices. © 2019 International Parkinson and Movement Disorder Society. SN - 1531-8257 UR - https://www.unboundmedicine.com/medline/citation/30719763/EuroInf_2:_Subthalamic_stimulation_apomorphine_and_levodopa_infusion_in_Parkinson's_disease_ L2 - https://doi.org/10.1002/mds.27626 DB - PRIME DP - Unbound Medicine ER -