Deep brain stimulation of the subthalamic nucleus: effectiveness in advanced Parkinson's disease patients previously reliant on apomorphine.
OBJECTIVE
To assess the efficacy of bilateral subthalamic nucleus (STN) deep brain stimulation (DBS) in patients with advanced Parkinson's disease previously reliant on apomorphine as their main antiparkinsonian medication.


METHODS
Seven patients with motor fluctuations despite optimal medical treatment given as predominantly apomorphine infusion (n=6), or intermittent apomorphine injections (n=1) underwent bilateral STN DBS using frameless stereotactic surgery. Standard assessments of parkinsonism and motor fluctuations, using Unified Parkinson's Disease Rating Scale (UPDRS) were performed before and six months after surgery. Assessments were performed both on and off medication, and postoperative with the stimulators switched on and off.


RESULTS
Bilateral STN DBS improved motor scores (UPDRS III) by 61% when off medication (p<0.05). Clinical fluctuations (UPDRS IV items 36-39) were reduced by 46.2% (p<0.05). Total daily apomorphine dose was reduced by 68.9% (p<0.05) and apomorphine infusion via a pump was no longer required in four patients. There were no operative complications. Two patients required treatment for hallucinations postoperatively but there was no significant change in mini-mental state examination.


CONCLUSIONS
In patients with advanced Parkinson's disease, previously reliant on apomorphine, bilateral STN DBS is an effective treatment to reduce motor fluctuations and enable a reduction in apomorphine use.
Varma
T R K
TR
Walton Centre for Neurology and Neurosurgery, Lower Lane, Fazakerley, Liverpool L9 7IJ, UK.
Fox
S H
SH
Eldridge
P R
PR
Littlechild
P
P
Byrne
P
P
Forster
A
A
Marshall
A
A
Cameron
H
H
McIver
K
K
Fletcher
N
N
Steiger
M
M
D000368:Aged; D000978:Antiparkinson Agents / Q000008:administration & dosage*; D001058:Apomorphine / Q000008:administration & dosage*; D003131:Combined Modality Therapy; D004292:Dominance, Cerebral / Q000502:physiology; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004599:Electric Stimulation Therapy; D004567:Electrodes, Implanted; D006801:Humans; D007279:Injections, Subcutaneous; D008297:Male; D008875:Middle Aged; D009043:Motor Activity / Q000187:drug effects / Q000502:physiology*; D009048:Motor Skills / Q000187:drug effects / Q000502:physiology*; D009460:Neurologic Examination / Q000187:drug effects; D010300:Parkinson Disease / Q000503:physiopathology / Q000628:therapy*; D020531:Subthalamic Nucleus / Q000503:physiopathology*; D016896:Treatment Outcome
D000978:Antiparkinson Agents; D001058:Apomorphine