Continuous perioperative apomorphine in deep brain stimulation surgery for Parkinson's disease.
BACKGROUND
Patients with Parkinson's disease (PD) deprived of dopaminergic medication to facilitate awake testing during the deep brain stimulation (DBS) procedure are at increased risk of neurologic deterioration.. The aim of this survey was to demonstrate the safety of subcutaneous apomorphine treatment for reducing surgery-related neurologic deterioration in patients undergoing DBS surgery for PD.


METHODS
Ninety-two patients who underwent DBS surgery for PD between 11/2007 and 10/2011 in our department were retrospectively analyzed for this survey. Demographic data, apomorphine dosage, side-effects and need of ICU/IMC stay were collected and analyzed.


RESULTS
Seventy-two out of 92 patients (78.3%) received apomorphine treatment; main reason for omission of treatment was intolerable nausea (16/92, 17.3%). Apomorphine treatment was well tolerated and the most common side effect was nodular panniculitis. No severe complications were observed. No patient required ICU/IMC stay related to dopaminergic deprivation.


CONCLUSIONS
Perioperative withdrawal of dopaminergic medication in PD patients leads to an increased risk of neurologic and respiratory deterioration during DBS procedures. These complications can likely be tempered using perioperative subcutaneous apomorphine as a substitute. Our 5-year experience indicates a reduction in postoperative neurologic deterioration and ICU/IMC stay need. We consider perioperative apomorphine safe during DBS surgery for PD.
Neurochirurgische Klinik, Heinrich-Heine-Universität , Düsseldorf , Germany.
Philipp Jörg
PJ
Slotty
Christian
C
Wille
Thomas Mehari
TM
Kinfe
Jan
J
Vesper
D000328:Adult; D000368:Aged; D000978:Antiparkinson Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D001058:Apomorphine / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D046690:Deep Brain Stimulation / Q000379:methods*; D005260:Female; D006801:Humans; D007260:Infusion Pumps; D008297:Male; D008875:Middle Aged; D009325:Nausea / Q000139:chemically induced / Q000453:epidemiology; D010300:Parkinson Disease / Q000150:complications / Q000188:drug therapy* / Q000601:surgery*; D019990:Perioperative Care / Q000379:methods*; D012189:Retrospective Studies; D013375:Substance Withdrawal Syndrome / Q000517:prevention & control / Q000523:psychology
D000978:Antiparkinson Agents; D001058:Apomorphine
Parkinson's disease; apomorphine; complication management; deep brain stimulation