Continuous Subcutaneous Apomorphine Infusion before Subthalamic Deep Brain Stimulation: A Prospective, Comparative Study in 20 Patients
| Autor: | José Luis Relova, Ángel Sesar, A. Castro, Miguel Gelabert, Eduardo Arán-Echabe, Gustavo Fernández-Pajarín, Isabel Jiménez-Martín, Begoña Ares |
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| Přispěvatelé: | Universidade de Santiago de Compostela. Departamento de Psiquiatría, Radioloxía, Saúde Pública, Enfermaría e Medicina |
| Rok vydání: | 2021 |
| Předmět: |
Deep brain stimulation
Parkinson's disease Apomorphine medicine.medical_treatment Subthalamic deep brain stimulation Disease apomorphine Quality of life Rating scale Medicine Apathy Research Articles Medical treatment business.industry device‐aided therapies medicine.disease subthalamic deep brain stimulation nervous system diseases surgical procedures operative nervous system Neurology Anesthesia Parkinson’s disease Neurology (clinical) medicine.symptom business therapeutics Research Article Device-aided therapies medicine.drug |
| Zdroj: | Movement Disorders Clinical Practice Minerva. Repositorio Institucional de la Universidad de Santiago de Compostela instname |
| ISSN: | 2330-1619 |
| DOI: | 10.1002/mdc3.13338 |
| Popis: | Background: Background Studies comparing the clinical efficacy of apomorphine infusion (APO) with subsequent subthalamic deep brain stimulation (STN-DBS) in advanced Parkinson’s disease (aPD) are currently lacking. Retrospective data have shown that patients treated with APO are usually older, have a more prolonged disease, and a more severe phenotype. Objective: Objective To compare the benefit of APO with that of STN-DBS on motor, non-motor, cognitive, and quality of life in the same patient when given sequentially. Methods: Methods We prospectively analyzed 20 aPD patients over 3 different treatment phases: baseline (optimized medical treatment), during APO treatment, and during subsequent STN-DBS treatment. The APO and STN-DBS phases were stable for 6 months, and evaluation of the different treatments was separated by 6 months. Results: Results Compared to baseline, APO, and STN-DBS reduced mean daily off time by 70.5% and 89.3% (P = 0.012), respectively, and scores for Unified Parkinson’s Disease Rating Scale (UPDRS) IV by 27.5% and 80.5% (P ≤ 0.001), Non-motor symptoms scale (NMSS) by 24.6% and 49.3% (P ≤ 0.001), Montgomery Asberg depression scale (MADRS) by 7.4% and 39.0% (P = 0.27), Starkstein apathy scale (SAS) by 51.1% and 39.9% (P = 0.734), Parkinson’s disease sleep scale 2 (PDSS-2) by 25.7% and 56.7% (P ≤ 0.001), and Parkinson’s disease questionnaire 39 item (PDQ-39) by 39.6% and 64.9% (P ≤ 0.001). Global cognition did not change with either therapy, but phonetic fluency worsened after STN-DBS compared to APO (P = 0.022). Conclusions: Conclusions Both APO and STN-DBS improved motor and non-motor symptoms and quality of life compared to optimized medical treatment in aPD. Overall, STN-DBS was the most effective treatment, but APO showed a pronounced benefit on motor symptoms. Effective treatment for aPD should not be delayed, even when waiting for surgery SI |
| Databáze: | OpenAIRE |
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