Clinical and neuropsychological follow up at 12 months in patients with complicated Parkinson’s disease treated with subcutaneous apomorphine infusion or deep brain stimulation of the subthalamic nucleus
Identifieur interne : 000814 ( Main/Corpus ); précédent : 000813; suivant : 000815Clinical and neuropsychological follow up at 12 months in patients with complicated Parkinson’s disease treated with subcutaneous apomorphine infusion or deep brain stimulation of the subthalamic nucleus
Auteurs : D. De Gaspari ; C. Siri ; A. Landi ; R. Cilia ; A. Bonetti ; F. Natuzzi ; L. Morgante ; C B Mariani ; E. Sganzerla ; G. Pezzoli ; A. AntoniniSource :
- Journal of Neurology, Neurosurgery & Psychiatry [ 0022-3050 ] ; 2006-04.
English descriptors
- KwdEn :
- AIMS, Abnormal Involuntary Movement Scale, APO, subcutaneous apomorphine infusion, CF, category fluency, CPM, Raven’s Coloured Progressive Matrices, CVLT, the California Verbal Learning Test, H&Y stage, Hoehn and Yahr stage, HDRS-17, Hamilton Depression Rating Scale-17, MMSE, Mini-Mental State Examination, NPI, Neuro-Psychiatric Inventory, PD, Parkinson’s disease, PF, phonemic fluency, PWL, Paired Word Learning, Parkinson’s disease, STN-DBS, STN-DBS, deep brain stimulation of the subthalamic nucleus, UPDRS-III, Unified Parkinson’s Disease Rating Scale motor examination, apomorphine, deep brain stimulation of the subthalamic nucleus, neuropsychology.
Abstract
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.
Url:
DOI: 10.1136/jnnp.2005.078659
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ISTEX:E2A7D7F2A591EBF3BB3A7192281B4D3A07FF92E4Le document en format XML
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Landi</name><affiliation><mods:affiliation>Clinica Neurochirurgica, Ospedale San Gerardo, Università Milano–Bicocca, Monza, Italy</mods:affiliation></affiliation></author><author><name sortKey="Cilia, R" sort="Cilia, R" uniqKey="Cilia R" first="R" last="Cilia">R. Cilia</name><affiliation><mods:affiliation>Centro Parkinson, Istituti Clinici di Perfezionamento, Milan, Italy</mods:affiliation></affiliation></author><author><name sortKey="Bonetti, A" sort="Bonetti, A" uniqKey="Bonetti A" first="A" last="Bonetti">A. Bonetti</name><affiliation><mods:affiliation>Centro Parkinson, Istituti Clinici di Perfezionamento, Milan, Italy</mods:affiliation></affiliation></author><author><name sortKey="Natuzzi, F" sort="Natuzzi, F" uniqKey="Natuzzi F" first="F" last="Natuzzi">F. 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De Gaspari</name><affiliation><mods:affiliation>Centro Parkinson, Istituti Clinici di Perfezionamento, Milan, Italy</mods:affiliation></affiliation></author><author><name sortKey="Siri, C" sort="Siri, C" uniqKey="Siri C" first="C" last="Siri">C. Siri</name><affiliation><mods:affiliation>Centro Parkinson, Istituti Clinici di Perfezionamento, Milan, Italy</mods:affiliation></affiliation></author><author><name sortKey="Landi, A" sort="Landi, A" uniqKey="Landi A" first="A" last="Landi">A. Landi</name><affiliation><mods:affiliation>Clinica Neurochirurgica, Ospedale San Gerardo, Università Milano–Bicocca, Monza, Italy</mods:affiliation></affiliation></author><author><name sortKey="Cilia, R" sort="Cilia, R" uniqKey="Cilia R" first="R" last="Cilia">R. Cilia</name><affiliation><mods:affiliation>Centro Parkinson, Istituti Clinici di Perfezionamento, Milan, Italy</mods:affiliation></affiliation></author><author><name sortKey="Bonetti, A" sort="Bonetti, A" uniqKey="Bonetti A" first="A" last="Bonetti">A. Bonetti</name><affiliation><mods:affiliation>Centro Parkinson, Istituti Clinici di Perfezionamento, Milan, Italy</mods:affiliation></affiliation></author><author><name sortKey="Natuzzi, F" sort="Natuzzi, F" uniqKey="Natuzzi F" first="F" last="Natuzzi">F. Natuzzi</name><affiliation><mods:affiliation>Centro Parkinson, Istituti Clinici di Perfezionamento, Milan, Italy</mods:affiliation></affiliation></author><author><name sortKey="Morgante, L" sort="Morgante, L" uniqKey="Morgante L" first="L" last="Morgante">L. Morgante</name><affiliation><mods:affiliation>Clinica Neurologica, Università di Messina, Messina, Italy</mods:affiliation></affiliation></author><author><name sortKey="Mariani, C B" sort="Mariani, C B" uniqKey="Mariani C" first="C B" last="Mariani">C B Mariani</name><affiliation><mods:affiliation>Centro Parkinson, Istituti Clinici di Perfezionamento, Milan, Italy</mods:affiliation></affiliation></author><author><name sortKey="Sganzerla, E" sort="Sganzerla, E" uniqKey="Sganzerla E" first="E" last="Sganzerla">E. Sganzerla</name><affiliation><mods:affiliation>Clinica Neurochirurgica, Ospedale San Gerardo, Università Milano–Bicocca, Monza, Italy</mods:affiliation></affiliation></author><author><name sortKey="Pezzoli, G" sort="Pezzoli, G" uniqKey="Pezzoli G" first="G" last="Pezzoli">G. Pezzoli</name><affiliation><mods:affiliation>Centro Parkinson, Istituti Clinici di Perfezionamento, Milan, Italy</mods:affiliation></affiliation></author><author><name sortKey="Antonini, A" sort="Antonini, A" uniqKey="Antonini A" first="A" last="Antonini">A. Antonini</name><affiliation><mods:affiliation>Centro Parkinson, Istituti Clinici di Perfezionamento, Milan, Italy</mods:affiliation></affiliation></author></analytic><monogr></monogr><series><title level="j">Journal of Neurology, Neurosurgery & Psychiatry</title><title level="j" type="abbrev">J Neurol Neurosurg Psychiatry</title><idno type="ISSN">0022-3050</idno><idno type="eISSN">1468-330X</idno><imprint><publisher>BMJ Publishing Group Ltd</publisher><date type="published" when="2006-04">2006-04</date><biblScope unit="volume">77</biblScope><biblScope unit="issue">4</biblScope><biblScope unit="page" from="450">450</biblScope></imprint><idno type="ISSN">0022-3050</idno></series><idno type="istex">E2A7D7F2A591EBF3BB3A7192281B4D3A07FF92E4</idno><idno type="DOI">10.1136/jnnp.2005.078659</idno><idno type="href">jnnp-77-450.pdf</idno><idno type="PMID">16543520</idno><idno type="local">0770450</idno></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">0022-3050</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>AIMS, Abnormal Involuntary Movement Scale</term><term>APO, subcutaneous apomorphine infusion</term><term>CF, category fluency</term><term>CPM, Raven’s Coloured Progressive Matrices</term><term>CVLT, the California Verbal Learning Test</term><term>H&Y stage, Hoehn and Yahr stage</term><term>HDRS-17, Hamilton Depression Rating Scale-17</term><term>MMSE, Mini-Mental State Examination</term><term>NPI, Neuro-Psychiatric Inventory</term><term>PD, Parkinson’s disease</term><term>PF, phonemic fluency</term><term>PWL, Paired Word Learning</term><term>Parkinson’s disease</term><term>STN-DBS</term><term>STN-DBS, deep brain stimulation of the subthalamic nucleus</term><term>UPDRS-III, Unified Parkinson’s Disease Rating Scale motor examination</term><term>apomorphine</term><term>deep brain stimulation of the subthalamic nucleus</term><term>neuropsychology</term></keywords></textClass><langUsage><language ident="en">en</language></langUsage></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">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.</div></front></TEI><istex><corpusName>bmj</corpusName><author><json:item><name>D De Gaspari</name><affiliations><json:string>Centro Parkinson, Istituti Clinici di Perfezionamento, Milan, Italy</json:string></affiliations></json:item><json:item><name>C Siri</name><affiliations><json:string>Centro Parkinson, Istituti Clinici di Perfezionamento, Milan, Italy</json:string></affiliations></json:item><json:item><name>A Landi</name><affiliations><json:string>Clinica Neurochirurgica, Ospedale San Gerardo, Università Milano–Bicocca, Monza, Italy</json:string></affiliations></json:item><json:item><name>R Cilia</name><affiliations><json:string>Centro Parkinson, Istituti Clinici di Perfezionamento, Milan, Italy</json:string></affiliations></json:item><json:item><name>A Bonetti</name><affiliations><json:string>Centro Parkinson, Istituti Clinici di Perfezionamento, Milan, Italy</json:string></affiliations></json:item><json:item><name>F Natuzzi</name><affiliations><json:string>Centro Parkinson, Istituti Clinici di Perfezionamento, Milan, Italy</json:string></affiliations></json:item><json:item><name>L Morgante</name><affiliations><json:string>Clinica Neurologica, Università di Messina, Messina, Italy</json:string></affiliations></json:item><json:item><name>C B Mariani</name><affiliations><json:string>Centro Parkinson, Istituti Clinici di Perfezionamento, Milan, Italy</json:string></affiliations></json:item><json:item><name>E Sganzerla</name><affiliations><json:string>Clinica Neurochirurgica, Ospedale San Gerardo, Università Milano–Bicocca, Monza, Italy</json:string></affiliations></json:item><json:item><name>G Pezzoli</name><affiliations><json:string>Centro Parkinson, Istituti Clinici di Perfezionamento, Milan, Italy</json:string></affiliations></json:item><json:item><name>A Antonini</name><affiliations><json:string>Centro Parkinson, Istituti Clinici di Perfezionamento, Milan, Italy</json:string></affiliations></json:item></author><subject><json:item><lang><json:string>eng</json:string></lang><value>Papers</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>AIMS, Abnormal Involuntary Movement Scale</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>APO, subcutaneous apomorphine infusion</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>CF, category fluency</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>CPM, Raven’s Coloured Progressive Matrices</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>CVLT, the California Verbal Learning Test</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>HDRS-17, Hamilton Depression Rating Scale-17</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>H&Y stage, Hoehn and Yahr stage</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>MMSE, Mini-Mental State Examination</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>NPI, Neuro-Psychiatric Inventory</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>PD, Parkinson’s disease</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>PF, phonemic fluency</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>PWL, Paired Word Learning</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>STN-DBS, deep brain stimulation of the subthalamic nucleus</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>UPDRS-III, Unified Parkinson’s Disease Rating Scale motor examination</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>apomorphine</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>deep brain stimulation of the subthalamic nucleus</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>neuropsychology</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>Parkinson’s disease</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>STN-DBS</value></json:item></subject><language><json:string>eng</json:string></language><abstract>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.</abstract><qualityIndicators><score>6.256</score><pdfVersion>1.4</pdfVersion><pdfPageSize>612 x 792 pts (letter)</pdfPageSize><refBibsNative>false</refBibsNative><keywordCount>20</keywordCount><abstractCharCount>1854</abstractCharCount><pdfWordCount>2756</pdfWordCount><pdfCharCount>19004</pdfCharCount><pdfPageCount>4</pdfPageCount><abstractWordCount>260</abstractWordCount></qualityIndicators><title>Clinical and neuropsychological follow up at 12 months in patients with complicated Parkinson’s disease treated with subcutaneous apomorphine infusion or deep brain stimulation of the subthalamic nucleus</title><pmid><json:string>16543520</json:string></pmid><genre><json:string>research-article</json:string></genre><host><volume>77</volume><pages><first>450</first></pages><issn><json:string>0022-3050</json:string></issn><issue>4</issue><genre></genre><language><json:string>unknown</json:string></language><eissn><json:string>1468-330X</json:string></eissn><title>Journal of Neurology, Neurosurgery & Psychiatry</title></host><publicationDate>2006</publicationDate><copyrightDate>2006</copyrightDate><doi><json:string>10.1136/jnnp.2005.078659</json:string></doi><id>E2A7D7F2A591EBF3BB3A7192281B4D3A07FF92E4</id><fulltext><json:item><original>true</original><mimetype>application/pdf</mimetype><extension>pdf</extension><uri>https://api.istex.fr/document/E2A7D7F2A591EBF3BB3A7192281B4D3A07FF92E4/fulltext/pdf</uri></json:item><json:item><original>false</original><mimetype>application/zip</mimetype><extension>zip</extension><uri>https://api.istex.fr/document/E2A7D7F2A591EBF3BB3A7192281B4D3A07FF92E4/fulltext/zip</uri></json:item><istex:fulltextTEI uri="https://api.istex.fr/document/E2A7D7F2A591EBF3BB3A7192281B4D3A07FF92E4/fulltext/tei"><teiHeader><fileDesc><titleStmt><title level="a" type="main" xml:lang="en">Clinical and neuropsychological follow up at 12 months in patients with complicated Parkinson’s disease treated with subcutaneous apomorphine infusion or deep brain stimulation of the subthalamic nucleus</title><respStmt xml:id="ISTEX-API" resp="Références bibliographiques récupérées via GROBID" name="ISTEX-API (INIST-CNRS)"></respStmt></titleStmt><publicationStmt><authority>ISTEX</authority><publisher>BMJ Publishing Group Ltd</publisher><availability><p>BMJ</p></availability><date>2006-03-16</date></publicationStmt><notesStmt><note>Correspondence to:
Angelo Antonini
Centro Parkinson, Istituti Clinici di Pefezionamento, 20126 Milan, Italy; angelo3000@yahoo.com</note></notesStmt><sourceDesc><biblStruct type="inbook"><analytic><title level="a" type="main" xml:lang="en">Clinical and neuropsychological follow up at 12 months in patients with complicated Parkinson’s disease treated with subcutaneous apomorphine infusion or deep brain stimulation of the subthalamic nucleus</title><author><persName><forename type="first">D</forename><surname>De Gaspari</surname></persName><affiliation>Centro Parkinson, Istituti Clinici di Perfezionamento, Milan, Italy</affiliation></author><author><persName><forename type="first">C</forename><surname>Siri</surname></persName><affiliation>Centro Parkinson, Istituti Clinici di Perfezionamento, Milan, Italy</affiliation></author><author><persName><forename type="first">A</forename><surname>Landi</surname></persName><affiliation>Clinica Neurochirurgica, Ospedale San Gerardo, Università Milano–Bicocca, Monza, Italy</affiliation></author><author><persName><forename type="first">R</forename><surname>Cilia</surname></persName><affiliation>Centro Parkinson, Istituti Clinici di Perfezionamento, Milan, Italy</affiliation></author><author><persName><forename type="first">A</forename><surname>Bonetti</surname></persName><affiliation>Centro Parkinson, Istituti Clinici di Perfezionamento, Milan, Italy</affiliation></author><author><persName><forename type="first">F</forename><surname>Natuzzi</surname></persName><affiliation>Centro Parkinson, Istituti Clinici di Perfezionamento, Milan, Italy</affiliation></author><author><persName><forename type="first">L</forename><surname>Morgante</surname></persName><affiliation>Clinica Neurologica, Università di Messina, Messina, Italy</affiliation></author><author><persName><forename type="first">C B</forename><surname>Mariani</surname></persName><affiliation>Centro Parkinson, Istituti Clinici di Perfezionamento, Milan, Italy</affiliation></author><author><persName><forename type="first">E</forename><surname>Sganzerla</surname></persName><affiliation>Clinica Neurochirurgica, Ospedale San Gerardo, Università Milano–Bicocca, Monza, Italy</affiliation></author><author><persName><forename type="first">G</forename><surname>Pezzoli</surname></persName><affiliation>Centro Parkinson, Istituti Clinici di Perfezionamento, Milan, Italy</affiliation></author><author><persName><forename type="first">A</forename><surname>Antonini</surname></persName><affiliation>Centro Parkinson, Istituti Clinici di Perfezionamento, Milan, Italy</affiliation></author></analytic><monogr><title level="j">Journal of Neurology, Neurosurgery & Psychiatry</title><title level="j" type="abbrev">J Neurol Neurosurg Psychiatry</title><idno type="pISSN">0022-3050</idno><idno type="eISSN">1468-330X</idno><imprint><publisher>BMJ Publishing Group Ltd</publisher><date type="published" when="2006-04"></date><biblScope unit="volume">77</biblScope><biblScope unit="issue">4</biblScope><biblScope unit="page" from="450">450</biblScope></imprint></monogr><idno type="istex">E2A7D7F2A591EBF3BB3A7192281B4D3A07FF92E4</idno><idno type="DOI">10.1136/jnnp.2005.078659</idno><idno type="href">jnnp-77-450.pdf</idno><idno type="PMID">16543520</idno><idno type="local">0770450</idno></biblStruct></sourceDesc></fileDesc><profileDesc><creation><date>2006-03-16</date></creation><langUsage><language ident="en">en</language></langUsage><abstract xml:lang="en"><p>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.</p></abstract><textClass xml:lang="en"><keywords scheme="keyword"><list><head>ABR</head><item><term>AIMS, Abnormal Involuntary Movement Scale</term></item><item><term>APO, subcutaneous apomorphine infusion</term></item><item><term>CF, category fluency</term></item><item><term>CPM, Raven’s Coloured Progressive Matrices</term></item><item><term>CVLT, the California Verbal Learning Test</term></item><item><term>HDRS-17, Hamilton Depression Rating Scale-17</term></item><item><term>H&Y stage, Hoehn and Yahr stage</term></item><item><term>MMSE, Mini-Mental State Examination</term></item><item><term>NPI, Neuro-Psychiatric Inventory</term></item><item><term>PD, Parkinson’s disease</term></item><item><term>PF, phonemic fluency</term></item><item><term>PWL, Paired Word Learning</term></item><item><term>STN-DBS, deep brain stimulation of the subthalamic nucleus</term></item><item><term>UPDRS-III, Unified Parkinson’s Disease Rating Scale motor examination</term></item></list></keywords></textClass><textClass xml:lang="en"><keywords scheme="keyword"><list><head>KWD</head><item><term>apomorphine</term></item><item><term>deep brain stimulation of the subthalamic nucleus</term></item><item><term>neuropsychology</term></item><item><term>Parkinson’s disease</term></item><item><term>STN-DBS</term></item></list></keywords></textClass></profileDesc><revisionDesc><change when="2006-03-16">Created</change><change when="2006-04">Published</change><change xml:id="refBibs-istex" who="#ISTEX-API" when="2016-3-14">References added</change></revisionDesc></teiHeader></istex:fulltextTEI><json:item><original>false</original><mimetype>text/plain</mimetype><extension>txt</extension><uri>https://api.istex.fr/document/E2A7D7F2A591EBF3BB3A7192281B4D3A07FF92E4/fulltext/txt</uri></json:item></fulltext><metadata><istex:metadataXml wicri:clean="corpus bmj" wicri:toSee="no header"><istex:xmlDeclaration>version="1.0" encoding="UTF-8" standalone="no"</istex:xmlDeclaration><istex:docType PUBLIC="-//NLM//DTD Journal Archiving and Interchange DTD v2.3 20070202//EN" URI="archivearticle.dtd" name="istex:docType"></istex:docType><istex:document><article xml:lang="en" article-type="research-article"><front><journal-meta><journal-id journal-id-type="hwp">jnnp</journal-id><journal-id journal-id-type="nlm-ta">J Neurol Neurosurg Psychiatry</journal-id><journal-title>Journal of Neurology, Neurosurgery & Psychiatry</journal-title><abbrev-journal-title abbrev-type="publisher">J Neurol Neurosurg Psychiatry</abbrev-journal-title><issn pub-type="ppub">0022-3050</issn><issn pub-type="epub">1468-330X</issn><publisher><publisher-name>BMJ Publishing Group Ltd</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="other">0770450</article-id><article-id pub-id-type="doi">10.1136/jnnp.2005.078659</article-id><article-id pub-id-type="other">jnnp;77/4/450</article-id><article-id pub-id-type="pmid">16543520</article-id><article-id pub-id-type="other">450</article-id><article-id pub-id-type="other">jnnp.2005.078659</article-id><article-categories><subj-group subj-group-type="heading"><subject content-type="original">Papers</subject></subj-group></article-categories><title-group><article-title>Clinical and neuropsychological follow up at 12 months in patients with complicated Parkinson’s disease treated with subcutaneous apomorphine infusion or deep brain stimulation of the subthalamic nucleus</article-title></title-group><contrib-group><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>De Gaspari</surname><given-names>D</given-names></name><xref rid="AFF1">1</xref><xref rid="FN1">*</xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Siri</surname><given-names>C</given-names></name><xref rid="AFF1">1</xref><xref rid="FN1">*</xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Landi</surname><given-names>A</given-names></name><xref rid="AFF2">2</xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Cilia</surname><given-names>R</given-names></name><xref rid="AFF1">1</xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Bonetti</surname><given-names>A</given-names></name><xref rid="AFF1">1</xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Natuzzi</surname><given-names>F</given-names></name><xref rid="AFF1">1</xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Morgante</surname><given-names>L</given-names></name><xref rid="AFF3">3</xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Mariani</surname><given-names>C B</given-names></name><xref rid="AFF1">1</xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Sganzerla</surname><given-names>E</given-names></name><xref rid="AFF2">2</xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Pezzoli</surname><given-names>G</given-names></name><xref rid="AFF1">1</xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Antonini</surname><given-names>A</given-names></name><xref rid="AFF1">1</xref></contrib><aff id="AFF1"><label>1</label>Centro Parkinson, Istituti Clinici di Perfezionamento, Milan, Italy</aff><aff id="AFF2"><label>2</label>Clinica Neurochirurgica, Ospedale San Gerardo, Università Milano–Bicocca, Monza, Italy</aff><aff id="AFF3"><label>3</label>Clinica Neurologica, Università di Messina, Messina, Italy</aff></contrib-group><author-notes><corresp>Correspondence to:
Angelo Antonini
Centro Parkinson, Istituti Clinici di Pefezionamento, 20126 Milan, Italy; <ext-link xlink:href="angelo3000@yahoo.com" ext-link-type="email" xlink:type="simple">angelo3000@yahoo.com</ext-link></corresp></author-notes><pub-date pub-type="ppub"><month>4</month><year>2006</year></pub-date><pub-date pub-type="epub"><day>16</day><month>3</month><year>2006</year></pub-date><volume>77</volume><volume-id pub-id-type="other">77</volume-id><volume-id pub-id-type="other">77</volume-id><issue>4</issue><issue-id pub-id-type="other">jnnp;77/4</issue-id><issue-id pub-id-type="other">4</issue-id><issue-id pub-id-type="other">77/4</issue-id><fpage>450</fpage><history><date date-type="accepted"><day>07</day><month>12</month><year>2005</year></date><date date-type="received"><day>18</day><month>08</month><year>2005</year></date><date date-type="rev-recd"><day>13</day><month>11</month><year>2005</year></date></history><permissions><copyright-statement>Copyright 2006 Journal of Neurology Neurosurgery and Psychiatry</copyright-statement><copyright-year>2006</copyright-year></permissions><self-uri content-type="pdf" xlink:role="full-text" xlink:href="jnnp-77-450.pdf"></self-uri><abstract xml:lang="en"><p><bold>Background:</bold> 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.</p><p><bold>Objective:</bold> 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.</p><p><bold>Methods:</bold> 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.</p><p><bold>Results:</bold> 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.</p><p><bold>Conclusions:</bold> 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.</p></abstract><kwd-group kwd-group-type="ABR" xml:lang="en"><kwd>AIMS, Abnormal Involuntary Movement Scale</kwd><kwd>APO, subcutaneous apomorphine infusion</kwd><kwd>CF, category fluency</kwd><kwd>CPM, Raven’s Coloured Progressive Matrices</kwd><kwd>CVLT, the California Verbal Learning Test</kwd><kwd>HDRS-17, Hamilton Depression Rating Scale-17</kwd><kwd>H&Y stage, Hoehn and Yahr stage</kwd><kwd>MMSE, Mini-Mental State Examination</kwd><kwd>NPI, Neuro-Psychiatric Inventory</kwd><kwd>PD, Parkinson’s disease</kwd><kwd>PF, phonemic fluency</kwd><kwd>PWL, Paired Word Learning</kwd><kwd>STN-DBS, deep brain stimulation of the subthalamic nucleus</kwd><kwd>UPDRS-III, Unified Parkinson’s Disease Rating Scale motor examination</kwd></kwd-group><kwd-group kwd-group-type="KWD" xml:lang="en"><kwd>apomorphine</kwd><kwd>deep brain stimulation of the subthalamic nucleus</kwd><kwd>neuropsychology</kwd><kwd>Parkinson’s disease</kwd><kwd>STN-DBS</kwd></kwd-group></article-meta></front></article></istex:document></istex:metadataXml><mods version="3.6"><titleInfo lang="en"><title>Clinical and neuropsychological follow up at 12 months in patients with complicated Parkinson’s disease treated with subcutaneous apomorphine infusion or deep brain stimulation of the subthalamic nucleus</title></titleInfo><titleInfo type="alternative" lang="en" contentType="CDATA"><title>Clinical and neuropsychological follow up at 12 months in patients with complicated Parkinson’s disease treated with subcutaneous apomorphine infusion or deep brain stimulation of the subthalamic nucleus</title></titleInfo><name type="personal"><namePart type="given">D</namePart><namePart type="family">De Gaspari</namePart><affiliation>Centro Parkinson, Istituti Clinici di Perfezionamento, Milan, Italy</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">C</namePart><namePart type="family">Siri</namePart><affiliation>Centro Parkinson, Istituti Clinici di Perfezionamento, Milan, Italy</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">A</namePart><namePart type="family">Landi</namePart><affiliation>Clinica Neurochirurgica, Ospedale San Gerardo, Università Milano–Bicocca, Monza, Italy</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">R</namePart><namePart type="family">Cilia</namePart><affiliation>Centro Parkinson, Istituti Clinici di Perfezionamento, Milan, Italy</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">A</namePart><namePart type="family">Bonetti</namePart><affiliation>Centro Parkinson, Istituti Clinici di Perfezionamento, Milan, Italy</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">F</namePart><namePart type="family">Natuzzi</namePart><affiliation>Centro Parkinson, Istituti Clinici di Perfezionamento, Milan, Italy</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">L</namePart><namePart type="family">Morgante</namePart><affiliation>Clinica Neurologica, Università di Messina, Messina, Italy</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">C B</namePart><namePart type="family">Mariani</namePart><affiliation>Centro Parkinson, Istituti Clinici di Perfezionamento, Milan, Italy</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">E</namePart><namePart type="family">Sganzerla</namePart><affiliation>Clinica Neurochirurgica, Ospedale San Gerardo, Università Milano–Bicocca, Monza, Italy</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">G</namePart><namePart type="family">Pezzoli</namePart><affiliation>Centro Parkinson, Istituti Clinici di Perfezionamento, Milan, Italy</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">A</namePart><namePart type="family">Antonini</namePart><affiliation>Centro Parkinson, Istituti Clinici di Perfezionamento, Milan, Italy</affiliation><role><roleTerm type="text">author</roleTerm></role></name><typeOfResource>text</typeOfResource><genre type="research-article" displayLabel="research-article"></genre><originInfo><publisher>BMJ Publishing Group Ltd</publisher><dateIssued encoding="w3cdtf">2006-04</dateIssued><dateCreated encoding="w3cdtf">2006-03-16</dateCreated><copyrightDate encoding="w3cdtf">2006</copyrightDate></originInfo><language><languageTerm type="code" authority="iso639-2b">eng</languageTerm><languageTerm type="code" authority="rfc3066">en</languageTerm></language><physicalDescription><internetMediaType>text/html</internetMediaType></physicalDescription><abstract lang="en">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.</abstract><note type="author-notes">Correspondence to:
Angelo Antonini
Centro Parkinson, Istituti Clinici di Pefezionamento, 20126 Milan, Italy; angelo3000@yahoo.com</note><subject lang="en"><genre>ABR</genre><topic>AIMS, Abnormal Involuntary Movement Scale</topic><topic>APO, subcutaneous apomorphine infusion</topic><topic>CF, category fluency</topic><topic>CPM, Raven’s Coloured Progressive Matrices</topic><topic>CVLT, the California Verbal Learning Test</topic><topic>HDRS-17, Hamilton Depression Rating Scale-17</topic><topic>H&Y stage, Hoehn and Yahr stage</topic><topic>MMSE, Mini-Mental State Examination</topic><topic>NPI, Neuro-Psychiatric Inventory</topic><topic>PD, Parkinson’s disease</topic><topic>PF, phonemic fluency</topic><topic>PWL, Paired Word Learning</topic><topic>STN-DBS, deep brain stimulation of the subthalamic nucleus</topic><topic>UPDRS-III, Unified Parkinson’s Disease Rating Scale motor examination</topic></subject><subject lang="en"><genre>KWD</genre><topic>apomorphine</topic><topic>deep brain stimulation of the subthalamic nucleus</topic><topic>neuropsychology</topic><topic>Parkinson’s disease</topic><topic>STN-DBS</topic></subject><relatedItem type="host"><titleInfo><title>Journal of Neurology, Neurosurgery & Psychiatry</title></titleInfo><titleInfo type="abbreviated"><title>J Neurol Neurosurg Psychiatry</title></titleInfo><genre type="Journal">journal</genre><identifier type="ISSN">0022-3050</identifier><identifier type="eISSN">1468-330X</identifier><identifier type="PublisherID-hwp">jnnp</identifier><identifier type="PublisherID-nlm-ta">J Neurol Neurosurg Psychiatry</identifier><part><date>2006</date><detail type="volume"><caption>vol.</caption><number>77</number></detail><detail type="issue"><caption>no.</caption><number>4</number></detail><extent unit="pages"><start>450</start></extent></part></relatedItem><identifier type="istex">E2A7D7F2A591EBF3BB3A7192281B4D3A07FF92E4</identifier><identifier type="DOI">10.1136/jnnp.2005.078659</identifier><identifier type="href">jnnp-77-450.pdf</identifier><identifier type="PMID">16543520</identifier><identifier type="local">0770450</identifier><accessCondition type="use and reproduction" contentType="copyright">Copyright 2006 Journal of Neurology Neurosurgery and Psychiatry</accessCondition><recordInfo><recordContentSource>BMJ</recordContentSource></recordInfo></mods></metadata><serie></serie></istex></record>Pour manipuler ce document sous Unix (Dilib)
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