Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Jul 17.
doi: 10.1002/mdc3.70240. Online ahead of print.

Subcutaneous Apomorphine Infusion Initiation Is Associated with Impulse Control Disorder Attenuation in Advanced Parkinson's Disease Patients: Insights from the French NS-Park Cohort

Clément Desjardins  1 , Paulo André Dias Bastos  2 , Aymeric Lanore  3 , Christine Brefel-Courbon  2 , Isabelle Benatru  4 , Caroline Giordana  5 , Anne Doe de Maindreville  6 , Giovanni Castelnovo  7 , Philippe Remy  8 , Luc Defebvre  9 , Claire Thiriez  10 , Stéphane Prange  11 , Jean-Luc Houeto  12 , Alexandra Samier Foubert  13   14 , Fabienne Ory-Magne  2 , Raquel Pinhero Barbosa  2 , Nathalie Bertille  15 , Jean-Christophe Corvol  16   17 , Olivier Rascol  2 , Margherita Fabbri  2 ; NS‐Part Cohort study group
Collaborators, Affiliations

Subcutaneous Apomorphine Infusion Initiation Is Associated with Impulse Control Disorder Attenuation in Advanced Parkinson's Disease Patients: Insights from the French NS-Park Cohort

Clément Desjardins et al. Mov Disord Clin Pract. .

Abstract

Background: Impulse control disorders (ICD) are common non-motor complications in Parkinson's disease (PD), particularly in patients receiving oral dopamine agonists (DA). Continuous subcutaneous apomorphine infusion (CSAI) is a device-aided therapy for advanced PD, but its effects on ICD remain underexplored in real-world settings.

Objectives: To assess the impact of CSAI initiation on ICD prevalence and severity in a large real-world PD cohort and to compare ICD evolution in CSAI-treated patients versus orally-treated controls.

Methods: We analyzed data from the national prospective observational NS-Park cohort, selecting patients with documented ICD status before and after CSAI initiation. Changes in ICD prevalence and severity based on the MDS-UPDRS sub-item 1.6 were assessed using paired statistical tests, with additional sensitivity analyses based on time-restricted sub-cohorts (considering 60-, 24- and 12-months follow-up). A matched case-control analysis and a propensity score matching were used to compare CSAI-treated patients to orally-treated PD patients.

Results: 149 patients were included in the analysis. Before CSAI initiation, slight and mild/severe ICDs were present in 17% and 5% of the patients, respectively. After CSAI starting, ICD prevalence significantly decreased from 22% to 13%, (P = 0.003). These improvements were consistent across different time windows, despite an overall increase in DA levodopa-equivalent dose, with no associated mood worsening (up to 24-month follow-up). CSAI was associated with longitudinal ICD reduction, contrasting with the stable or worsening ICD trajectory in orally-treated controls, though trajectories were not statistically different.

Conclusions: The presented findings of our real-life cohort suggest that ICD tend to improve following CSAI initiation in patients with PD, likely due to a reduction of oral DA or the effect of continuous dopaminergic stimulation provided by the pump. While this observation is clinically relevant, it should be interpreted with caution given the study's observational design and the limitations inherent to using MDS-UPDRS sub-items for ICD assessment.

Keywords: Parkinson's disease; cohort; continuous‐subcutaneous apomorphine infusion; impulse control disorders.

PubMed Disclaimer

References

    1. Katzenschlager R, Poewe W, Rascol O, et al. Apomorphine subcutaneous infusion in patients with Parkinson's disease with persistent motor fluctuations (TOLEDO): a multicentre, double‐blind, randomised, placebo‐controlled trial. Lancet Neurol 2018;17(9):749–759.
    1. Kukkle PL, Garg D, Merello M. Continuous subcutaneous infusion delivery of Apomorphine in Parkinson's disease: A systematic review. Mov Disord Clin Pract 2023;10(9):1253–1267.
    1. Phokaewvarangkul O, Anan C, Phimpha A, Chaudhuri KR, van Laar T, Bhidayasiri R. Early factors for predicting discontinuation to subcutaneous Apomorphine infusion in Parkinson's disease: A prospective analysis of the Thai Apomorphine registry. Parkinsonism Relat Disord 2021;91:146–151.
    1. Phokaewvarangkul O, Auffret M, Groppa S, Markovic V, Petrovic I, Bhidayasiri R. What was first and what is next in selecting device‐aided therapy in Parkinson's disease? Balancing evidence and experience. J Neural Transm Vienna Austria 1996;131(11):1307–1320.
    1. Deuschl G, Antonini A, Costa J, et al. European academy of neurology/Movement Disorder Society‐European section guideline on the treatment of Parkinson's disease: I. Invasive therapies. Mov Disord 2022;37(7):1360–1374.

LinkOut - more resources