April 2006
De Gaspari D, Siri C, Landi A, Cilia R, Bonetti A, Natuzzi F, Morgante L, Mariani CB, Sganzerla E, Pezzoli G, Antonini A
Background: The clinical condition of
advanced Parkinson’s disease (PD) patients is often complicated by motor
fluctuations and dyskinesias which are difficult to control with
available oral medications.
Objective: To compare clinical and neuropsychological 12 month outcome following subcutaneous apomorphine infusion (APO) and chronic
deep brain stimulation of the subthalamic nucleus (STN-DBS) in advanced PD patients.
Methods:
Patients with advanced PD and medically untreatable fluctuations
underwent either APO (13 patients) or STN-DBS (12 patients).
All patients were clinically
(UPDRS-III, AIMS, 12 h on-off daily) and neuropsychologically (MMSE,
Hamilton-17 depression,
NPI) evaluated at baseline and at 12
months. APO was discontinued at night.
Results: At
12 months APO treatment (74.78±24.42 mg/day) resulted in significant
reduction in off time (−51%) and no change in AIMS. Levodopa equivalent
medication doses were reduced from 665.98±215 mg/day at baseline to
470±229 mg/day. MMSE, NPI, and Hamilton depression scores were
unchanged. At 12 months STN-DBS resulted in significant clinical
improvement in terms of reduction in daily off time (−76%) and AIMS
(−81%) as well as levodopa equivalent medication doses (980±835 to
374±284 mg/day). Four out of 12 patients had stopped oral medications.
MMSE was unchanged (from 28.6±0.3 to 28.4±0.6). Hamilton depression was
also unchanged, but NPI showed significant worsening (from 6.58±9.8 to
18.16±10.2; p<0.02). Category fluency also declined.
Conclusions:
Both APO and STN-DBS resulted in significant clinical improvement in
complicated PD. STN-DBS resulted in greater reduction
in dopaminergic medications and
provided 24 h motor benefit. However, STN-DBS, unlike APO, appears to be
associated with significant
worsening on NPI resulting from long
term behavioral problems in some patients.
