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Observational Study
. 2019 Mar;34(3):353-365.
doi: 10.1002/mds.27626. Epub 2019 Feb 4.

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

Haidar S Dafsari  1   2 , Pablo Martinez-Martin  3 , Alexandra Rizos  2 , Maja Trost  4 , Maria Gabriela Dos Santos Ghilardi  5 , Prashanth Reddy  2 , Anna Sauerbier  2   6 , Jan Niklas Petry-Schmelzer  1 , Milica Kramberger  4 , Robbert W K Borgemeester  7 , Michael T Barbe  1 , Keyoumars Ashkan  2 , Monty Silverdale  8 , Julian Evans  8 , Per Odin  9   10 , Erich Talamoni Fonoff  5   11 , Gereon R Fink  1   12 , Tove Henriksen  13 , Georg Ebersbach  14 , Zvezdan Pirtošek  4 , Veerle Visser-Vandewalle  15 , Angelo Antonini  16   17 , Lars Timmermann  1   18 , K Ray Chaudhuri  2   6 ; EUROPAR and the International Parkinson and Movement Disorders Society Non-Motor Parkinson's Disease Study Group
Affiliations
Observational Study

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

Haidar S Dafsari et al. Mov Disord. 2019 Mar.

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. © 2019 International Parkinson and Movement Disorder Society.

Keywords: Apomorphine; Deep brain stimulation; Intrajejunal levodopa infusion; Nonmotor symptoms; Quality of life.

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