TY - JOUR
T1 - EuroInf 2
T2 - Subthalamic stimulation, apomorphine, and levodopa infusion in Parkinson's disease
AU - EUROPAR
AU - Int Parkinson Movement Disorder
AU - Dafsari, Haidar S.
AU - Martinez-Martin, Pablo
AU - Rizos, Alexandra
AU - Trost, Maja
AU - dos Santos Ghilardi, Maria Gabriela
AU - Reddy, Prashanth
AU - Sauerbier, Anna
AU - Petry-Schmelzer, Jan Niklas
AU - Kramberger, Milica
AU - Borgemeester, Robbert W. K.
AU - Barbe, Michael T.
AU - Ashkan, Keyoumars
AU - Silverdale, Monty
AU - Evans, Julian
AU - Odin, Per
AU - Fonoff, Erich Talamoni
AU - Fink, Gereon R.
AU - Henriksen, Tove
AU - Ebersbach, Georg
AU - Pirtosek, Zvezdan
AU - Visser-Vandewalle, Veerle
AU - Antonini, Angelo
AU - Timmermann, Lars
AU - Chaudhuri, K. Ray
AU - Schrag, Anette
AU - Weintraub, Daniel
AU - Barone, Paolo
AU - Brooks, David J.
AU - Brown, Richard G.
AU - Jenner, Peter
AU - Jeon, B.
AU - Lyons, Kelly
AU - Pavese, Nicola
AU - Politis, Marios
AU - Postuma, Ronald B.
AU - Schapira, Anthony
AU - Stocchi, Fabrizio
AU - Tsuboi, Yoshio
AU - van Laar, Teus
PY - 2019/3
Y1 - 2019/3
N2 - 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. (c) 2019 International Parkinson and Movement Disorder Society
AB - 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. (c) 2019 International Parkinson and Movement Disorder Society
KW - Apomorphine
KW - Deep brain stimulation
KW - Intrajejunal levodopa infusion
KW - Nonmotor symptoms
KW - Quality of life
KW - DEEP-BRAIN-STIMULATION
KW - CARBIDOPA INTESTINAL GEL
KW - QUALITY-OF-LIFE
KW - NONMOTOR SYMPTOMS
KW - SUBCUTANEOUS APOMORPHINE
KW - DOUBLE-BLIND
KW - MOTOR
KW - NUCLEUS
KW - NEUROSTIMULATION
KW - HALLUCINATIONS
U2 - 10.1002/mds.27626
DO - 10.1002/mds.27626
M3 - Article
SN - 0885-3185
VL - 34
SP - 353
EP - 365
JO - Movement Disorders
JF - Movement Disorders
IS - 3
ER -