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Scientific article
English

Apomorphine infusion in advanced Parkinson's patients with subthalamic stimulation contraindications

Published inParkinsonism & Related Disorders, vol. 18, no. 1, p. 40-44
Publication date2012
Abstract

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 studywas to evaluate the efficacy and cognitive safety of APO at 12-month followup 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.

Keywords
  • Parkinson's disease
  • Subcutaneous apomorphine infusion
  • Neuropsychological assessment
  • Axial motor symptoms
Citation (ISO format)
DRAPIER, Sophie et al. Apomorphine infusion in advanced Parkinson’s patients with subthalamic stimulation contraindications. In: Parkinsonism & Related Disorders, 2012, vol. 18, n° 1, p. 40–44. doi: 10.1016/j.parkreldis.2011.08.010
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ISSN of the journal1353-8020
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