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

Forskningsoutput: TidskriftsbidragArtikel i vetenskaplig tidskrift

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.

Detaljer

Författare
  • EUROPAR
  • 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 Pirtošek
  • Veerle Visser-Vandewalle
  • Angelo Antonini
  • Lars Timmermann
  • K. Ray Chaudhuri
Enheter & grupper
Externa organisationer
  • University Hospital of Cologne
  • King's College Hospital
  • University Medical Centre Ljubljana
  • University of São Paulo
  • King's College London
  • University Medical Center Groningen
  • University of Manchester
  • Central Hospital Bremerhaven
  • Jülich Research Centre
  • Bispebjerg Hospital
  • University of Padova
  • University Hospital Giessen and Marburg
  • Carlos III Health Institute
  • University of Groningen
  • Syrian-Lebanese Hospital
  • Kliniken Beelitz GmbH
  • San Camillo Hospital
Forskningsområden

Ämnesklassifikation (UKÄ) – OBLIGATORISK

  • Neurologi

Nyckelord

Originalspråkengelska
TidskriftMovement Disorders
StatusPublished - 2019 feb 4
PublikationskategoriForskning
Peer review utfördJa