Objective: To address comparative demographic and other variables for Parkinson’s disease patients at baseline for infusion therapies (subcutaneous apomorphine (Apo), intrajejunal levodopa (IJLI)) and deep brain stimulation of the subthalamic nucleus (DBS) and to compare follow up data across specialist centres in movement disorders in Europe.

Background: The Euroinf study as well as studies with DBS suggest wide variability in parameters affecting patient selection as well as outcome. (Martinez-Martin et al 2015, Haidar S Dafsari et al 2015).

Methods: Standardised assessments of motor, non-motor and quality of life outcomes as well as demographic variables were collected in all consecutive patients undergoing Apo, IJLI or DBS therapies, selected at the discretion of the local centre clinicians and patients. Data from 44 patients on IJLI infusion, 43 on Apo and 42 on DBS are available with follow up assessments at 6 months. Kruskal-Wallis equality-of-populations rank test was used with Benjamini-Hochberg correction for multiple comparisons.

Results: There were no significant differences in age of patients selected for advanced therapies between the groups, although patients with DBS were slightly younger (average 59.8±8.2 yrs vs 62.7±9.1 for IJLI and 62.3±10.6 yrs for Apo). Duration of PD before advanced treatment was significantly lower (p<0.0004) in DBS (10.7±4.9yrs) compared to Apo (14.04±4.4 yrs), or IJLI (16±6.7yrs). In terms of severity of PD (Hoehn and Yahr stage (HY)), significantly more severe patients were in the IJLI group, more moderate in the Apo group, and more mild in the DBS group (p=0.001). All three therapies showed a positive impact on motor and all nine domains of the PD Non-Motor Symptom Scale, the improvements in non-motor symptoms ranging from 23% (Apo) to 37% (IJLI). The effect of therapies at follow up compared to baseline showed worsening of attention/memory (not significant) and miscellaneous domain (significant, p=0.0004) for DBS only.

Conclusions: While age range of patients selected for advanced therapies was similar across all centres, more severe patients (as judged by HY stage) were selected for IJLI and patients with lower disease duration for DBS. All therapies show a consistent improvement in motor and all domains of the Non-Motor Symptoms Scale, except for a slight worsening of attention/memory and a deterioration in the miscellaneous domain for DBS.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/a-multi-centre-european-comparative-survey-of-advanced-therapies-infusion-and-deep-brain-stimulation-in-parkinsons-disease/