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

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  3. Sensorimotor subthalamic stimulation restores risk-reward trade-off in Parkinson's disease

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  4. The biomarker potential of cell-free microRNA from cerebrospinal fluid in Parkinsonian Syndromes

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  1. Challenges in conducting paediatric trials with off-patent drugs

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  2. Parkinson patients have a presynaptic serotonergic deficit: A dynamic deep brain stimulation PET study

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  3. Close relationships in Parkinson´s disease patients with device-aided therapy

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  • EUROPAR and the International Parkinson and Movement Disorders Society Non-Motor Parkinson's Disease Study Group
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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. © 2019 International Parkinson and Movement Disorder Society.

Original languageEnglish
JournalMovement disorders : official journal of the Movement Disorder Society
Volume34
Issue number3
Pages (from-to)353-365
Number of pages13
ISSN0885-3185
DOIs
Publication statusPublished - Mar 2019

    Research areas

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

ID: 58251450