Continuous Subcutaneous Apomorphine Infusion before Subthalamic Deep Brain Stimulation: A Prospective, Comparative...

Area of Science:

• Neurology
• Neurosurgery
• Movement Disorders

Background:

• Lack of comparative studies on apomorphine infusion (APO) and subthalamic deep brain stimulation (STN-DBS) in advanced Parkinson's disease (aPD).
• Retrospective data suggest APO patients are older with more severe disease.
• Need to evaluate sequential treatment benefits in the same patients.

Purpose of the Study:

• To prospectively compare the efficacy of APO and STN-DBS in aPD patients.
• To assess sequential treatment effects on motor, non-motor, cognitive, and quality of life outcomes.
• To determine the optimal treatment strategy for advanced Parkinson's disease.

Main Methods:

• Prospective analysis of 20 aPD patients over three phases: baseline, APO treatment, and STN-DBS treatment.
• Stable treatment phases for 6 months each, with 6-month intervals between evaluations.
• Assessment of motor, non-motor, cognitive, and quality of life measures.

Main Results:

• Both APO and STN-DBS significantly reduced 'off' time and improved UPDRS IV, NMSS, PDSS-2, and PDQ-39 scores compared to baseline.
• STN-DBS demonstrated greater efficacy than APO across most measures, including motor and non-motor symptoms.
• Phonetic fluency declined after STN-DBS compared to APO, while global cognition remained unchanged.

Conclusions:

• Both APO and STN-DBS offer significant improvements for aPD patients compared to optimized medical treatment.
• STN-DBS is generally more effective, but APO provides notable motor symptom benefits.
• Treatment for aPD should not be delayed while awaiting surgical intervention.