Manon Auffret1, Florence Le Jeune2, Anne Maurus3, Sophie Drapier4, Jean-François Houvenaghel5, Gabriel Hadrien Robert6, Paul Sauleau7, Marc Vérin8. 1. Behavior and Basal Ganglia research unit (EA 4712), University of Rennes 1, Rennes, France. Electronic address: auffret.manon@gmail.com. 2. Behavior and Basal Ganglia research unit (EA 4712), University of Rennes 1, Rennes, France; Nuclear Medicine Unit, Oncology Department Eugène Marquis Center, Rennes, France. Electronic address: f.lejeune@rennes.unicancer.fr. 3. Behavior and Basal Ganglia research unit (EA 4712), University of Rennes 1, Rennes, France; Movement Disorders Unit, Neurology Department, Pontchaillou University Hospital, Rennes, France. Electronic address: Anne.MAURUS@chu-rennes.fr. 4. Behavior and Basal Ganglia research unit (EA 4712), University of Rennes 1, Rennes, France; Movement Disorders Unit, Neurology Department, Pontchaillou University Hospital, Rennes, France. Electronic address: Sophie.Drapier@chu-rennes.fr. 5. Behavior and Basal Ganglia research unit (EA 4712), University of Rennes 1, Rennes, France; Movement Disorders Unit, Neurology Department, Pontchaillou University Hospital, Rennes, France. Electronic address: Jeanfrancois.HOUVENAGHEL@chu-rennes.fr. 6. Behavior and Basal Ganglia research unit (EA 4712), University of Rennes 1, Rennes, France; Academic Department of Psychiatry, Guillaume Régnier Hospital, Rennes, France. Electronic address: gabriel.hadrien.robert@gmail.com. 7. Behavior and Basal Ganglia research unit (EA 4712), University of Rennes 1, Rennes, France; Neurophysiology Unit, Neurology Department, Rennes University Hospital, France. Electronic address: paul.sauleau@gmail.com. 8. Behavior and Basal Ganglia research unit (EA 4712), University of Rennes 1, Rennes, France; Movement Disorders Unit, Neurology Department, Pontchaillou University Hospital, Rennes, France. Electronic address: marc.verin@chu-rennes.fr.
Abstract
INTRODUCTION: Patients with advanced Parkinson's disease (PD) and contraindications for subthalamic nucleus deep brain stimulation (DBS) could particularly benefit from subcutaneous infusion therapy with apomorphine. This original study was designed to evaluate the general efficacy of add-on apomorphine in motor and nonmotor symptoms in advanced PD, while characterizing the changes induced in brain glucose metabolism. The aim was to look at the underlying anatomical-functional pathways. METHODS: 12 patients with advanced PD were assessed before and after 6months of add-on apomorphine, using resting-state 18F-fluorodeoxyglucose positron emission tomography and exhaustive clinical assessments. RESULTS: After 6months of therapy, oral treatment was significantly reduced. Both motor and nonmotor scores improved, with a beneficial effect on executive functions, quality of life and apathy. Significant metabolic changes were observed, with overall increases in the right fusiform gyrus and hippocampus, alongside a decrease in the left middle frontal gyrus. Consistent correlations between significant changes in clinical scores and metabolism were established. CONCLUSION: Well tolerated, add-on apomorphine appears to be an interesting option for patients with fluctuations and contra-indications for DBS. Changes in brain metabolism, with beneficial effects on motor and nonmotor symptoms were observed after 6months. These preliminary results have to be confirmed by further studies.
INTRODUCTION:Patients with advanced Parkinson's disease (PD) and contraindications for subthalamic nucleus deep brain stimulation (DBS) could particularly benefit from subcutaneous infusion therapy with apomorphine. This original study was designed to evaluate the general efficacy of add-on apomorphine in motor and nonmotor symptoms in advanced PD, while characterizing the changes induced in brain glucose metabolism. The aim was to look at the underlying anatomical-functional pathways. METHODS: 12 patients with advanced PD were assessed before and after 6months of add-on apomorphine, using resting-state 18F-fluorodeoxyglucose positron emission tomography and exhaustive clinical assessments. RESULTS: After 6months of therapy, oral treatment was significantly reduced. Both motor and nonmotor scores improved, with a beneficial effect on executive functions, quality of life and apathy. Significant metabolic changes were observed, with overall increases in the right fusiform gyrus and hippocampus, alongside a decrease in the left middle frontal gyrus. Consistent correlations between significant changes in clinical scores and metabolism were established. CONCLUSION: Well tolerated, add-on apomorphine appears to be an interesting option for patients with fluctuations and contra-indications for DBS. Changes in brain metabolism, with beneficial effects on motor and nonmotor symptoms were observed after 6months. These preliminary results have to be confirmed by further studies.
Authors: Kévin Ahrweiller; J F Houvenaghel; A Riou; S Drapier; P Sauleau; C Haegelen; P Jannin; M Vérin; X Palard; F Le Jeune Journal: J Neurol Date: 2019-07-26 Impact factor: 4.849