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 : 001339 ( Main/Exploration ); précédent : 001338; suivant : 001340Clinical 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 [Italie] ; C. Siri [Italie] ; A. Landi [Italie] ; R. Cilia [Italie] ; A. Bonetti [Italie] ; F. Natuzzi [Italie] ; L. Morgante [Italie] ; C B Mariani [Italie] ; E. Sganzerla [Italie] ; G. Pezzoli [Italie] ; A. Antonini [Italie]Source :
- 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
Affiliations:
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Antonini</name><affiliation wicri:level="3"><country xml:lang="fr">Italie</country><wicri:regionArea>Centro Parkinson, Istituti Clinici di Perfezionamento, Milan</wicri:regionArea><placeName><settlement type="city">Milan</settlement><region nuts="2">Lombardie</region></placeName></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><affiliations><list><country><li>Italie</li></country><region><li>Lombardie</li></region><settlement><li>Milan</li></settlement></list><tree><country name="Italie"><region name="Lombardie"><name sortKey="De Gaspari, D" sort="De Gaspari, D" uniqKey="De Gaspari D" first="D" last="De Gaspari">D. De Gaspari</name></region><name sortKey="Antonini, A" sort="Antonini, A" uniqKey="Antonini A" first="A" last="Antonini">A. Antonini</name><name sortKey="Bonetti, A" sort="Bonetti, A" uniqKey="Bonetti A" first="A" last="Bonetti">A. Bonetti</name><name sortKey="Cilia, R" sort="Cilia, R" uniqKey="Cilia R" first="R" last="Cilia">R. Cilia</name><name sortKey="Landi, A" sort="Landi, A" uniqKey="Landi A" first="A" last="Landi">A. Landi</name><name sortKey="Mariani, C B" sort="Mariani, C B" uniqKey="Mariani C" first="C B" last="Mariani">C B Mariani</name><name sortKey="Morgante, L" sort="Morgante, L" uniqKey="Morgante L" first="L" last="Morgante">L. Morgante</name><name sortKey="Natuzzi, F" sort="Natuzzi, F" uniqKey="Natuzzi F" first="F" last="Natuzzi">F. Natuzzi</name><name sortKey="Pezzoli, G" sort="Pezzoli, G" uniqKey="Pezzoli G" first="G" last="Pezzoli">G. Pezzoli</name><name sortKey="Sganzerla, E" sort="Sganzerla, E" uniqKey="Sganzerla E" first="E" last="Sganzerla">E. Sganzerla</name><name sortKey="Siri, C" sort="Siri, C" uniqKey="Siri C" first="C" last="Siri">C. Siri</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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