EuroInf: A Multicenter Comparative Observational Study of Apomorphine and Levodopa Infusion in Parkinson's Disease

Research output: Contribution to journalArticle


Subcutaneous apomorphine infusion (Apo) and intrajejunal levodopa infusion (IJLI) are two treatment options for patients with advanced Parkinson's disease (PD) and refractory motor complications, with varying cost of treatment. There are no multicenter studies comparing the effects of the two strategies. This open-label, prospective, observational, 6-month, multicenter study compared 43 patients on Apo (48.8% males, age 62.3 +/- 10.6 years; disease duration: 14 +/- 4.4 years; median H & Y stage 3; interquartile range [IQR]: 3-4) and 44 on IJLI (56.8% males, age 62.7 +/- 9.1 years; disease duration: 16.1 +/- 6.7 years; median H & Y stage 4; IQR, 3-4). Cohen's effect sizes (0.8 considered as large) were large with both therapies with respect to total motor, nonmotor, and quality-of-life scores. The Non-Motor Symptoms Scale (NMSS) with Apo showed moderate improvement, whereas sleep/fatigue, gastrointestinal, urinary, and sexual dimensions of the NMSS showed significantly higher improvement with IJLI. Seventy-five percent on IJLI improved in their quality-of-life and nonmotor symptoms (NMS), whereas in the Apo group, a similar proportion improved in quality of life, but 40% in NMS. Adverse effects included peritonitis with IJLI and skin nodules on Apo. Based on this open-label, nonrandomized, comparative study, we report that, in advanced Parkinson's patients, both IJLI and Apo infusion therapy appear to provide a robust improvement in motor symptoms, motor complications, quality-of-life, and some NMS. Controlled, randomized studies are required. (c) 2014 International Parkinson and Movement Disorder Society


  • Pablo Martinez-Martin
  • Prashanth Reddy
  • Regina Katzenschlager
  • Angelo Antonini
  • Antoniya Todorova
  • Tove Henriksen
  • Anne Martin
  • Daniela Calandrella
  • Alexandra Rizos
  • Narissah Bryndum
  • Arne Glad
  • Haidar Salimi Dafsari
  • Lars Timmermann
  • Georg Ebersbach
  • Milica G. Kramberger
  • Michael Samuel
  • Karoline Wenzel
  • Volker Tomantschger
  • Alexander Storch
  • Heinz Reichmann
  • Zvezdan Pirtosek
  • Maja Trost
  • Per Svenningsson
  • Sven Palhagen
  • Jens Volkmann
  • K. Ray Chaudhuri
External organisations
  • Karolinska Institutet
Research areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Neurology


  • Parkinson's disease, nonmotor symptoms, apomorphine infusion, intrajejunal levodopa infusion, quality of life
Original languageEnglish
Pages (from-to)510-516
JournalMovement Disorders
Issue number4
Publication statusPublished - 2015
Publication categoryResearch