TY - JOUR
T1 - Selecting deep brain stimulation or infusion therapies in advanced Parkinson's disease
T2 - an evidence-based review
AU - Volkmann, Jens
AU - Albanese, Alberto
AU - Antonini, Angelo
AU - Chaudhuri, K Ray
AU - Clarke, Carl E
AU - de Bie, Rob M A
AU - Deuschl, Günther
AU - Eggert, Karla
AU - Houeto, Jean-Luc
AU - Kulisevsky, Jaime
AU - Nyholm, Dag
AU - Odin, Per
AU - Ostergaard, Karen
AU - Poewe, Werner
AU - Pollak, Pierre
AU - Rabey, Jose Martin
AU - Rascol, Olivier
AU - Ruzicka, Evzen
AU - Samuel, Michael
AU - Speelman, Hans
AU - Sydow, Olof
AU - Valldeoriola, Francesc
AU - van der Linden, Chris
AU - Oertel, Wolfgang
PY - 2013/1/5
Y1 - 2013/1/5
N2 - 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.
AB - 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.
U2 - 10.1007/s00415-012-6798-6
DO - 10.1007/s00415-012-6798-6
M3 - Article
C2 - 23287972
SN - 1351-5101
JO - European Journal of Neurology
JF - European Journal of Neurology
ER -