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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
  1. D De Gaspari1,*,
  2. C Siri1,*,
  3. A Landi2,
  4. R Cilia1,
  5. A Bonetti1,
  6. F Natuzzi1,
  7. L Morgante3,
  8. C B Mariani1,
  9. E Sganzerla2,
  10. G Pezzoli1,
  11. A Antonini1
  1. 1Centro Parkinson, Istituti Clinici di Perfezionamento, Milan, Italy
  2. 2Clinica Neurochirurgica, Ospedale San Gerardo, Università Milano–Bicocca, Monza, Italy
  3. 3Clinica Neurologica, Università di Messina, Messina, Italy
  1. Correspondence to:
 Angelo Antonini
 Centro Parkinson, Istituti Clinici di Pefezionamento, 20126 Milan, Italy; angelo3000{at}yahoo.com

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.

  • AIMS, Abnormal Involuntary Movement Scale
  • APO, subcutaneous apomorphine infusion
  • CF, category fluency
  • CPM, Raven’s Coloured Progressive Matrices
  • CVLT, the California Verbal Learning Test
  • HDRS-17, Hamilton Depression Rating Scale-17
  • H&Y stage, Hoehn and Yahr stage
  • MMSE, Mini-Mental State Examination
  • NPI, Neuro-Psychiatric Inventory
  • PD, Parkinson’s disease
  • PF, phonemic fluency
  • PWL, Paired Word Learning
  • STN-DBS, deep brain stimulation of the subthalamic nucleus
  • UPDRS-III, Unified Parkinson’s Disease Rating Scale motor examination
  • apomorphine
  • deep brain stimulation of the subthalamic nucleus
  • neuropsychology
  • Parkinson’s disease
  • STN-DBS
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Footnotes

  • * These authors have equally contributed to this work

  • Competing interests: none declared

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