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

• Published in: Journal of neurology, neurosurgery and psychiatry Vol. 77; no. 4; pp. 450 - 453
• Main Authors: De Gaspari, D, Siri, C, Landi, A, Cilia, R, Bonetti, A, Natuzzi, F, Morgante, L, Mariani, C B, Sganzerla, E, Pezzoli, G, Antonini, A
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd 01.04.2006; BMJ; BMJ Publishing Group LTD; BMJ Group
• Subjects: Abnormal Involuntary Movement Scale; Aged; AIMS; Antiparkinson Agents - administration & dosage; Antiparkinson Agents - therapeutic use; Apathy; APO; apomorphine; Apomorphine - administration & dosage; Apomorphine - therapeutic use; Biological and medical sciences; category fluency; Cognition Disorders - diagnosis; Cognition Disorders - etiology; CPM; CVLT; Deep Brain Stimulation - instrumentation; deep brain stimulation of the subthalamic nucleus; Degenerative and inherited degenerative diseases of the nervous system. Leukodystrophies. Prion diseases; Drug Administration Schedule; Female; Follow-Up Studies; H&Y stage; Hamilton Depression Rating Scale-17; HDRS-17; Hoehn and Yahr stage; Humans; Injections, Subcutaneous; Levodopa - therapeutic use; Male; Medical sciences; Middle Aged; Mini-Mental State Examination; MMSE; Multiple sclerosis and variants. Guillain barré syndrome and other inflammatory polyneuropathies. Leukoencephalitis; Neuro-Psychiatric Inventory; Neurology; Neuropsychological Tests; neuropsychology; NPI; Paired Word Learning; Parkinson Disease - complications; Parkinson Disease - drug therapy; Parkinson Disease - therapy; Parkinson's disease; phonemic fluency; Phonetics; PWL; Raven’s Coloured Progressive Matrices; Severity of Illness Index; STN-DBS; Studies; subcutaneous apomorphine infusion; Subthalamic Nucleus - physiology; the California Verbal Learning Test; Unified Parkinson’s Disease Rating Scale motor examination; UPDRS-III; Human; Nervous system diseases; Subcutaneous; Deep brain stimulation; Central nervous system; Parkinson disease; Cerebral disorder; Treatment; Central nervous system disease; Complication; Degenerative disease; Subthalamic nucleus; Extrapyramidal syndrome
• ISSN: 0022-3050; 1468-330X
• DOI: 10.1136/jnnp.2005.078659

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.