title: Apomorphine infusion in advanced Parkinson's patients with subthalamic stimulation contraindications.
abstract: BACKGROUND
  The efficacy of continuous subcutaneous apomorphine infusion (APO) has been evaluated in advanced Parkinson's disease in several open-label studies but never in a population of patients for whom subthalamic nucleus deep brain stimulation (STN-DBS) was contraindicated.
  
  
  METHODS
  The aim of this study was to evaluate the efficacy and cognitive safety of APO at 12-month follow-up in 23 advanced parkinsonian patients (mean age: 62.3 years; mean disease duration: 13.9 years) whose dopa-resistant axial motor symptoms and/or cognitive decline constituted contraindications for STN-DBS. Their motor and cognitive status were evaluated before APO and 12 months afterwards.
  
  
  RESULTS
  After one year, patients expressed high levels of satisfaction, with a mean rating on the Visual Analog Scale of 52.8% under APO. Daily OFF time, recorded in a 24-h diary, was reduced by 36% and ON time improved by 48%. There was a significant reduction (-26%) in mean oral levodopa equivalent dose. Dopa-resistant axial symptoms and neuropsychological performance remained stable. No adverse event was noted and none of the patients needed to take clozapine at any time.
  
  
  CONCLUSIONS
  APO is both safe and effective in advanced parkinsonian patients with untreatable motor fluctuations, for whom STN-DBS is contraindicated due to dopa-resistant axial motor symptoms and/or cognitive decline. As such, it should be regarded as a viable alternative for these patients.
authors: Department of Neurology, University Hospital, Service de Neurologie, CHU Pontchaillou, 2 rue Henri le Guilloux, 35033 Rennes Cedex, France. sophie.drapier@chu-rennes.fr
authors: Sophie
authors: S
authors: Drapier
authors: Anne-Sophie
authors: AS
authors: Gillioz
authors: Emmanuelle
authors: E
authors: Leray
authors: Julie
authors: J
authors: Péron
authors: Tiphaine
authors: T
authors: Rouaud
authors: Annaig
authors: A
authors: Marchand
authors: Marc
authors: M
authors: Vérin
mesh_terms: D000368:Aged; D000978:Antiparkinson Agents / Q000008:administration & dosage*; D001058:Apomorphine / Q000008:administration & dosage*; D000075202:Contraindications; D046690:Deep Brain Stimulation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D055104:Infusions, Subcutaneous; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000188:drug therapy* / Q000503:physiopathology* / Q000523:psychology; D012720:Severity of Illness Index; D020531:Subthalamic Nucleus; D016896:Treatment Outcome
chemical_list: D000978:Antiparkinson Agents; D001058:Apomorphine