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Dr. Okun

New Study: Comparing DBS and Subcutaneous Apomorphine in Parkinson's

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Dear forum members,


DBS and Apomorphine pumps are both available to treat off time, dyskinesia and complications from these issues.


According to these authors DBS may be better on dyskinesia, but worse in neurocognitive side effects. Both are good for off time.


These types of comparisons will be important to help patients and physicians select therapies.


We will also need comparisons that include another therapy called Duodopa (a tube in the stomach that delivers levodopa through a pump).


Here is the article abstract:


J Neurol. 2010 Oct 23. [Epub ahead of print]

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

Antonini A, Isaias IU, Rodolfi G, Landi A, Natuzzi F, Siri C, Pezzoli G.


Parkinson Institute, Istituti Clinici di Perfezionamento, Via Bignami, 1, 20126, Milan, Italy.


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.


PMID: 20972684 [PubMed - as supplied by publisher]

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