BACKGROUND: The efficacy of continuous subcutaneous apomorphine infusion (APO) has been evaluated in advanced Parkinson's disease in several open-label studies but never in a population of patients for whom subthalamic nucleus deep brain stimulation (STN-DBS) was contraindicated. METHODS: The aim of this study was to evaluate the efficacy and cognitive safety of APO at 12-month follow-up in 23 advanced parkinsonian patients (mean age: 62.3 years; mean disease duration: 13.9 years) whose dopa-resistant axial motor symptoms and/or cognitive decline constituted contraindications for STN-DBS. Their motor and cognitive status were evaluated before APO and 12 months afterwards. RESULTS: After one year, patients expressed high levels of satisfaction, with a mean rating on the Visual Analog Scale of 52.8% under APO. Daily OFF time, recorded in a 24-h diary, was reduced by 36% and ON time improved by 48%. There was a significant reduction (-26%) in mean oral levodopa equivalent dose. Dopa-resistant axial symptoms and neuropsychological performance remained stable. No adverse event was noted and none of the patients needed to take clozapine at any time. CONCLUSIONS: APO is both safe and effective in advanced parkinsonian patients with untreatable motor fluctuations, for whom STN-DBS is contraindicated due to dopa-resistant axial motor symptoms and/or cognitive decline. As such, it should be regarded as a viable alternative for these patients.
BACKGROUND: The efficacy of continuous subcutaneous apomorphine infusion (APO) has been evaluated in advanced Parkinson's disease in several open-label studies but never in a population of patients for whom subthalamic nucleus deep brain stimulation (STN-DBS) was contraindicated. METHODS: The aim of this study was to evaluate the efficacy and cognitive safety of APO at 12-month follow-up in 23 advanced parkinsonianpatients (mean age: 62.3 years; mean disease duration: 13.9 years) whose dopa-resistant axial motor symptoms and/or cognitive decline constituted contraindications for STN-DBS. Their motor and cognitive status were evaluated before APO and 12 months afterwards. RESULTS: After one year, patients expressed high levels of satisfaction, with a mean rating on the Visual Analog Scale of 52.8% under APO. Daily OFF time, recorded in a 24-h diary, was reduced by 36% and ON time improved by 48%. There was a significant reduction (-26%) in mean oral levodopa equivalent dose. Dopa-resistant axial symptoms and neuropsychological performance remained stable. No adverse event was noted and none of the patients needed to take clozapine at any time. CONCLUSIONS: APO is both safe and effective in advanced parkinsonianpatients with untreatable motor fluctuations, for whom STN-DBS is contraindicated due to dopa-resistant axial motor symptoms and/or cognitive decline. As such, it should be regarded as a viable alternative for these patients.
Authors: Rejko Krüger; Rüdiger Hilker; Christian Winkler; Michael Lorrain; Matthias Hahne; Christoph Redecker; Paul Lingor; Wolfgang H Jost Journal: J Neural Transm (Vienna) Date: 2015-07-03 Impact factor: 3.575
Authors: Silvia Rota; Daniele Urso; Daniel J van Wamelen; Valentina Leta; Iro Boura; Per Odin; Alberto J Espay; Peter Jenner; K Ray Chaudhuri Journal: Transl Neurodegener Date: 2022-10-13 Impact factor: 9.883
Authors: Tomasz Fundament; Paul R Eldridge; Alexander L Green; Alan L Whone; Rod S Taylor; Adrian C Williams; W M Michael Schuepbach Journal: PLoS One Date: 2016-07-21 Impact factor: 3.240