Objective: The objetive of this study was to compare the benefit of APO and STN-DBS in aPD in terms of motor (off daily hours, UPDRS III, UPDRS IV and dyskinesia score), non-motor (NMSS, MADRS, SAS, PDSS-2), cognitive (MDRS and verbal fluency), quality of life (PDQ-39) and medication (levodopa and LEDD) in the same patient.
Background: Apomorphine infusion (APO) and subthalamic deep brain stimulation (STN-DBS) have shown their effectiveness in the treatment of advanced Parkinson’s disease (aPD). However, while several prospective, randomised, and multicenter clinical trials support STN-DBS, only one does the same for APO [1,2]. Data have shown that patients with APO are usually older, have more prolonged disease and a more severe phenotype [1-9]. Only two non-randomised and prospective studies have compared APO and STN-DBS in patients meeting the intervention [10,11].
Method: We prospectively analysed 20 aPD patients (Table 1) in three situations, baseline (ON-MED), APO and STN-DBS, for a time from 12 to 18 months. APO and STN-DBS phase were stable for 6 months. APO and STN-DBS evaluations were separated by 6 months to avoid disease progression.
Results: Compared to baseline, APO and STN-DBS reduced off-time by 70.5% and 89.3% (between both treatments, p =0.012), UPDRS IV by 27.5% and 80.5% (p ≤0.001), levodopa by 26.8% and 39.5% (p =0.024), NMSS by 24.6% and 49.3% (p ≤0.001), MADRS by 7.4% and 39.0 (p =0.27), SAS by 51.1% and 39.9% (p =0.734), PDSS-2 by 25.7% and 56.7% (P ≤0.001) and PDQ-39 by 39.6% and 64.9% (p ≤0.001). Dyskinesia improved dramatically after STN-DBS (78.7%) and did not change with APO. Global cognition did not modify with any therapy, but phonetic fluency worsened after STN-DBS (p =0.022). Results and statistical analysis are shown in table 2.
Conclusion: This is the first prospective study that compares APO and STN-DBS in the same patient. APO and STN-DBS have improved motor and non-motor symptoms and quality of life of these aPD patients compared to baseline. STN-DBS has been the most effective treatment, but APO has shown a notable benefit for this patient profile’s motor symptoms. Overall cognition did not change with APO or STN-DBS, except for a worsening of phonetic fluency after the intervention. We should not delay an appropriate treatment for aPD.
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To cite this abstract in AMA style:
G. Fernández-Pajarín, A. Sesar, B. Ares, I. Jimenez-Martín, M. Gelabert-González, E. Arán-Echabe, JL. Relova, A. Castro. Apomorphine infusion before subthalamic deep brain stimulation. A prospective comparative study in the same 20 patients. [abstract]. Mov Disord. 2021; 36 (suppl 1). https://www.mdsabstracts.org/abstract/apomorphine-infusion-before-subthalamic-deep-brain-stimulation-a-prospective-comparative-study-in-the-same-20-patients/. Accessed September 7, 2024.« Back to MDS Virtual Congress 2021
MDS Abstracts - https://www.mdsabstracts.org/abstract/apomorphine-infusion-before-subthalamic-deep-brain-stimulation-a-prospective-comparative-study-in-the-same-20-patients/