title: Selecting deep brain stimulation or infusion therapies in advanced Parkinson's disease: an evidence-based review.
abstract: Motor complications in Parkinson's disease (PD) result from the short half-life and irregular plasma fluctuations of oral levodopa. When strategies of providing more continuous dopaminergic stimulation by adjusting oral medication fail, patients may be candidates for one of three device-aided therapies: deep brain stimulation (DBS), continuous subcutaneous apomorphine infusion, or continuous duodenal/jejunal levodopa/carbidopa pump infusion (DLI). These therapies differ in their invasiveness, side-effect profile, and the need for nursing care. So far, very few comparative studies have evaluated the efficacy of the three device-aided therapies for specific motor problems in advanced PD. As a result, neurologists currently lack guidance as to which therapy could be most appropriate for a particular PD patient. A group of experts knowledgeable in all three therapies reviewed the currently available literature for each treatment and identified variables of clinical relevance for choosing one of the three options such as type of motor problems, age, and cognitive and psychiatric status. For each scenario, pragmatic and (if available) evidence-based recommendations are provided as to which patients could be candidates for either DBS, DLI, or subcutaneous apomorphine.
authors.affiliation: Department of Neurology, University Clinic of Würzburg, Josef-Schneider-Str. 11, 97080, Würzburg, Germany, volkmann_j@klinik.uni-wuerzburg.de.
authors.forename: Jens
authors.initials: J
authors.lastname: Volkmann
authors.forename: Alberto
authors.initials: A
authors.lastname: Albanese
authors.forename: Angelo
authors.initials: A
authors.lastname: Antonini
authors.forename: K Ray
authors.initials: KR
authors.lastname: Chaudhuri
authors.forename: Carl E
authors.initials: CE
authors.lastname: Clarke
authors.forename: Rob M A
authors.initials: RM
authors.lastname: de Bie
authors.forename: Günther
authors.initials: G
authors.lastname: Deuschl
authors.forename: Karla
authors.initials: K
authors.lastname: Eggert
authors.forename: Jean-Luc
authors.initials: JL
authors.lastname: Houeto
authors.forename: Jaime
authors.initials: J
authors.lastname: Kulisevsky
authors.forename: Dag
authors.initials: D
authors.lastname: Nyholm
authors.forename: Per
authors.initials: P
authors.lastname: Odin
authors.forename: Karen
authors.initials: K
authors.lastname: Østergaard
authors.forename: Werner
authors.initials: W
authors.lastname: Poewe
authors.forename: Pierre
authors.initials: P
authors.lastname: Pollak
authors.forename: Jose Martin
authors.initials: JM
authors.lastname: Rabey
authors.forename: Olivier
authors.initials: O
authors.lastname: Rascol
authors.forename: Evzen
authors.initials: E
authors.lastname: Ruzicka
authors.forename: Michael
authors.initials: M
authors.lastname: Samuel
authors.forename: Hans
authors.initials: H
authors.lastname: Speelman
authors.forename: Olof
authors.initials: O
authors.lastname: Sydow
authors.forename: Francesc
authors.initials: F
authors.lastname: Valldeoriola
authors.forename: Chris
authors.initials: C
authors.lastname: van der Linden
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Oertel
mesh_terms: D000978:Antiparkinson Agents / Q000008:administration & dosage*; D001058:Apomorphine / Q000008:administration & dosage; D002230:Carbidopa / Q000008:administration & dosage; D046690:Deep Brain Stimulation; D004333:Drug Administration Routes; D055317:Evidence-Based Practice; D006801:Humans; D007980:Levodopa / Q000008:administration & dosage; D010300:Parkinson Disease / Q000628:therapy*
chemical_list: D000978:Antiparkinson Agents; D007980:Levodopa; D002230:Carbidopa; D001058:Apomorphine