Journal of Neurology

, Volume 258, Issue 4, pp 579–585

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

  • Angelo Antonini
  • Ioannis U. Isaias
  • Giorgia Rodolfi
  • Andrea Landi
  • Francesca Natuzzi
  • Chiara Siri
  • Gianni Pezzoli
Original Communication

DOI: 10.1007/s00415-010-5793-z

Cite this article as:
Antonini, A., Isaias, I.U., Rodolfi, G. et al. J Neurol (2011) 258: 579. doi:10.1007/s00415-010-5793-z

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.

Keywords

ApomorphineDeep brain stimulationParkinson disease

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

Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Angelo Antonini
    • 1
    • 2
    • 3
  • Ioannis U. Isaias
    • 1
    • 4
  • Giorgia Rodolfi
    • 1
  • Andrea Landi
    • 5
  • Francesca Natuzzi
    • 1
  • Chiara Siri
    • 1
  • Gianni Pezzoli
    • 1
  1. 1.Parkinson Institute, Istituti Clinici di PerfezionamentoMilanItaly
  2. 2.Department for Parkinson’s diseaseIRCCS San CamilloVeniceItaly
  3. 3.University of PaduaPaduaItaly
  4. 4.Department of Human PhysiologyUniversity of MilanoMilanItaly
  5. 5.Department of NeurosurgeryOspedale San Gerardo, University of Milano BicoccaMonzaItaly