EuroInf 2: Subthalamic stimulation, apomorphine, and levodopa infusion in Parkinson's disease

Haidar S. Dafsari, Pablo Martinez-Martin, Alexandra Rizos, Maja Trost, Maria Gabriela dos Santos Ghilardi, Prashanth Reddy, Anna Sauerbier, Jan Niklas Petry-Schmelzer, Milica Kramberger, Robbert W.K. Borgemeester, Michael T. Barbe, Keyoumars Ashkan, Monty Silverdale, Julian Evans, Per Odin, Erich Talamoni Fonoff, Gereon R. Fink, Tove Henriksen, Georg Ebersbach, Zvezdan PirtošekVeerle Visser-Vandewalle, Angelo Antonini, Lars Timmermann, K. Ray Chaudhuri, EUROPAR

Research output: Contribution to journalArticlepeer-review

76 Citations (SciVal)

Abstract

Objective: Real-life observational report of clinical efficacy of bilateral subthalamic stimulation (STN-DBS), apomorphine (APO), and intrajejunal levodopa infusion (IJLI) on quality of life, motor, and nonmotor symptoms (NMS) in Parkinson's disease (PD). Methods: In this prospective, multicenter, international, real-life cohort observation study of 173 PD patients undergoing STN-DBS (n = 101), IJLI (n = 33), or APO (n = 39) were followed-up using PDQuestionnaire-8, NMSScale (NMSS), Unified PD Rating Scale (UPDRS)-III, UPDRS-IV, and levodopa equivalent daily dose (LEDD) before and 6 months after intervention. Outcome changes were analyzed with Wilcoxon signed-rank or paired t test when parametric tests were applicable. Multiple comparisons were corrected (multiple treatments/scales). Effect strengths were quantified with relative changes, effect size, and number needed to treat. Analyses were computed before and after propensity score matching, balancing demographic and clinical characteristics. Results: In all groups, PDQuestionnaire-8, UPDRS-IV, and NMSS total scores improved significantly at follow-up. Levodopa equivalent daily dose was significantly reduced after STN-DBS. Explorative NMSS domain analyses resulted in distinct profiles: STN-DBS improved urinary/sexual functions, mood/cognition, sleep/fatigue, and the miscellaneous domain. IJLI improved the 3 latter domains and gastrointestinal symptoms. APO improved mood/cognition, perceptual problems/hallucinations, attention/memory, and the miscellaneous domain. Overall, STN-DBS and IJLI seemed favorable for NMSS total score, and APO favorable for neuropsychological/neuropsychiatric NMS and PDQuestionnaire-8 outcome. Conclusions: This is the first comparison of quality of life, nonmotor. and motor outcomes in PD patients undergoing STN-DBS, IJLI, and APO in a real-life cohort. Distinct effect profiles were identified for each treatment option. Our results highlight the importance of holistic nonmotor and motor symptoms assessments to personalize treatment choices.

Original languageEnglish
JournalMovement Disorders
DOIs
Publication statusPublished - 2019 Feb 4

Subject classification (UKÄ)

  • Neurology

Keywords

  • Apomorphine
  • Deep brain stimulation
  • Intrajejunal levodopa infusion
  • Nonmotor symptoms
  • Quality of life

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