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A 5-year prospective assessment of advanced Parkinson disease patients treated with subcutaneous apomorphine infusion or deep brain stimulation

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Abstract

Prospective comparative long-term data on the effect of deep brain stimulation (DBS) of the subthalamic nucleus (STN) and continuous subcutaneous infusion of apomorphine (CSAI) in patients with advanced Parkinson disease (PD) are lacking. We report 5-year follow-up of 25 PD patients treated with either STN-DBS (n = 13) or CSAI (n = 12) who fulfilled CAPSIT-PD criteria. Cohorts were matched for disease duration and severity of motor complications. Baseline clinical and neuropsychological status did not differ among cohorts. Patients were assessed with the UPDRS, MMSE, HAMD-17 and Neuropsychiatric Inventory (NPI).Twelve subjects reached the 5-year follow-up with STN-DBS (one was lost at follow-up) versus two in the CSAI cohort. Drop-outs with CSAI were due to subcutaneous nodules (n = 2), insufficient control of motor fluctuations and dyskinesia (n = 4), death for unrelated reasons (n = 3) and one was lost at follow-up. Average apomorphine dose at last visit was 83.4 ± 19.2 mg/day and average treatment duration was 30 months. At 1-year as well as at last follow-up (intention-to-treat analysis), both therapies decreased daily off-time but only STN-DBS reduced dyskinesia duration and severity. Decrement of medications was greater with STN-DBS. There was a significant worsening of NPI after STN-DBS, primarily because four subjects developed apathy.

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Abbreviations

CF:

Category fluency

CPM:

Raven’s Colored Progressive Matrices

CSAI:

Continuous subcutaneous apomorphine infusion

CVLT:

California Verbal Learning Test

HAMD-17:

Hamilton Depression Rating Scale-17

H&Y:

Hoehn and Yahr

MMSE:

Mini-Mental State Examination

NPI:

Neuropsychiatric Inventory

PF:

Phonemic fluency

PWL:

Paired Word Learning

STN-DBS:

Subthalamic nucleus-deep brain stimulation

UPDRS:

Unified Parkinson Disease Rating Scale

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Acknowledgments

All authors approve the contents of the submission and none has conflict of interest regarding this study. IUI, GR, AL, FN, CS, GP: stock ownership in medically-related fields, consultancies, advisory boards, partnerships, honoraria, grants, intellectual property rights, expert testimony and royalties for the past year and 12 months preceding this study: none. AA received speaking honoraria by GE Healthcare, Boehringer-Ingelheim, Solvay, Novartis, UCB and GSK not related to the conduction of this study; stock ownership in medically-related fields, advisory boards, partnerships, grants, intellectual property rights, expert testimony and royalties for the past year and 12 months preceding this study: none. The study was funded in part by a grant of the Grigioni Foundation for Parkinson’s disease.

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Authors and Affiliations

  1. Parkinson Institute, Istituti Clinici di Perfezionamento, Via Bignami, 1, 20126, Milan, Italy

    Angelo Antonini, Ioannis U. Isaias, Giorgia Rodolfi, Francesca Natuzzi, Chiara Siri & Gianni Pezzoli

  2. Department for Parkinson’s disease, IRCCS San Camillo, Venice, Italy

    Angelo Antonini

  3. University of Padua, Padua, Italy

    Angelo Antonini

  4. Department of Human Physiology, University of Milano, Milan, Italy

    Ioannis U. Isaias

  5. Department of Neurosurgery, Ospedale San Gerardo, University of Milano Bicocca, Monza, Italy

    Andrea Landi

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  1. Angelo Antonini
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Correspondence to Ioannis U. Isaias.

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Antonini, A., Isaias, I.U., Rodolfi, G. et al. A 5-year prospective assessment of advanced Parkinson disease patients treated with subcutaneous apomorphine infusion or deep brain stimulation. J Neurol 258, 579–585 (2011). https://doi.org/10.1007/s00415-010-5793-z

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  • DOI: https://doi.org/10.1007/s00415-010-5793-z

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