title: Apomorphine pump in advanced Parkinson's disease: Effects on motor and nonmotor symptoms with brain metabolism correlations.
abstract: BACKGROUND
  Patients with advanced Parkinson's disease (PD) and contraindications for subthalamic nucleus deep brain stimulation (DBS) could particularly benefit from subcutaneous infusion therapy with apomorphine. This original study was designed to evaluate the general efficacy of add-on apomorphine in motor and nonmotor symptoms in advanced PD, while characterizing the changes induced in brain glucose metabolism. The aim was to look at the underlying anatomical-functional pathways.
  
  
  METHODS
  12 patients with advanced PD were assessed before and after 6months of add-on apomorphine, using resting-state18F-fluorodeoxyglucose positron emission tomography and exhaustive clinical assessments.
  
  
  RESULTS
  After 6months of therapy, oral treatment was significantly reduced. Both motor and nonmotor scores improved, with a beneficial effect on executive functions, quality of life and apathy. Significant metabolic changes were observed, with overall increases in the right fusiform gyrus and hippocampus, alongside a decrease in the left middle frontal gyrus. Consistent correlations between significant changes in clinical scores and metabolism were established.
  
  
  CONCLUSIONS
  Well tolerated, add-on apomorphine appears to be an interesting option for patients with fluctuations and contra-indications for DBS. Changes in brain metabolism, with beneficial effects on motor and nonmotor symptoms were observed after 6months. These preliminary results have to be confirmed by further studies.
authors.affiliation: Behavior and Basal Ganglia research unit (EA 4712), University of Rennes 1, Rennes, France. Electronic address: auffret.manon@gmail.com.
authors.forename: Manon
authors.initials: M
authors.lastname: Auffret
authors.affiliation: Behavior and Basal Ganglia research unit (EA 4712), University of Rennes 1, Rennes, France; Nuclear Medicine Unit, Oncology Department Eugène Marquis Center, Rennes, France. Electronic address: f.lejeune@rennes.unicancer.fr.
authors.forename: Florence
authors.initials: F
authors.lastname: Le Jeune
authors.affiliation: Behavior and Basal Ganglia research unit (EA 4712), University of Rennes 1, Rennes, France; Movement Disorders Unit, Neurology Department, Pontchaillou University Hospital, Rennes, France. Electronic address: Anne.MAURUS@chu-rennes.fr.
authors.forename: Anne
authors.initials: A
authors.lastname: Maurus
authors.affiliation: Behavior and Basal Ganglia research unit (EA 4712), University of Rennes 1, Rennes, France; Movement Disorders Unit, Neurology Department, Pontchaillou University Hospital, Rennes, France. Electronic address: Sophie.Drapier@chu-rennes.fr.
authors.forename: Sophie
authors.initials: S
authors.lastname: Drapier
authors.affiliation: Behavior and Basal Ganglia research unit (EA 4712), University of Rennes 1, Rennes, France; Movement Disorders Unit, Neurology Department, Pontchaillou University Hospital, Rennes, France. Electronic address: Jeanfrancois.HOUVENAGHEL@chu-rennes.fr.
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Houvenaghel
authors.affiliation: Behavior and Basal Ganglia research unit (EA 4712), University of Rennes 1, Rennes, France; Academic Department of Psychiatry, Guillaume Régnier Hospital, Rennes, France. Electronic address: gabriel.hadrien.robert@gmail.com.
authors.forename: Gabriel Hadrien
authors.initials: GH
authors.lastname: Robert
authors.affiliation: Behavior and Basal Ganglia research unit (EA 4712), University of Rennes 1, Rennes, France; Neurophysiology Unit, Neurology Department, Rennes University Hospital, France. Electronic address: paul.sauleau@gmail.com.
authors.forename: Paul
authors.initials: P
authors.lastname: Sauleau
authors.affiliation: Behavior and Basal Ganglia research unit (EA 4712), University of Rennes 1, Rennes, France; Movement Disorders Unit, Neurology Department, Pontchaillou University Hospital, Rennes, France. Electronic address: marc.verin@chu-rennes.fr.
authors.forename: Marc
authors.initials: M
authors.lastname: Vérin
mesh_terms: D000368:Aged; D001058:Apomorphine / Q000627:therapeutic use*; D001921:Brain / Q000000981:diagnostic imaging* / Q000187:drug effects* / Q000378:metabolism*; D018491:Dopamine Agonists / Q000627:therapeutic use*; D005260:Female; D019788:Fluorodeoxyglucose F18 / Q000378:metabolism; D006801:Humans; D008297:Male; D008875:Middle Aged; D009043:Motor Activity / Q000187:drug effects; D010300:Parkinson Disease / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000503:physiopathology; D049268:Positron-Emission Tomography; D012720:Severity of Illness Index; D013223:Statistics as Topic; D018709:Statistics, Nonparametric
chemical_list: D018491:Dopamine Agonists; D019788:Fluorodeoxyglucose F18; D001058:Apomorphine
keywords: Apomorphine pump; Brain metabolism; Nonmotor; PET; Parkinson's disease