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Rambour M, Moreau C, Salleron J, Devos D, Kreisler A, Mutez E, Simonin C, Annic A, Dujardin K, Destée A, Defebvre L. [Continuous subcutaneous infusion of apomorphine in Parkinson's disease: retrospective analysis of a series of 81 patients]. Rev Neurol (Paris) 2014; 170:205-15. [PMID: 24594365 DOI: 10.1016/j.neurol.2013.10.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Revised: 09/26/2013] [Accepted: 10/31/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND Continuous subcutaneous infusion of apomorphine (CAI) has shown efficacy in the treatment of motor fluctuations but its place in the therapeutic arsenal remains poorly defined in terms of indication, acceptability and long-term tolerance. Indeed, few studies have been carried out with a follow-up greater than 12 months. The main objective was to assess the quality of life of Parkinson's disease (PD) patients treated with CAI. We also evaluate the effectiveness on the motor fluctuations, the long-term tolerance of this treatment with its causes of discontinuation and the treatment regimens used. METHODS We conducted a retrospective study of 81 PD patients treated with CAI between April 2003 and June 2012. Data were collected from medical records. A repeated measures analysis of variance by the linear mixed model was used (significance level: 5%). RESULTS In August 2012, 27/81 patients were still treated with CAI with a mean duration of 28 months, 46/81 discontinued CAI (9 precociously), and 8 were lost to view. We didn't show improvement in the quality of life nor efficacy of CAI on the UPDRS IV score (P=0.54) and dyskinesia score (P=0.95). The CGI score patient also reflects this result with a majority response suggesting no significant change with CAI. We observed relative good cognitive and psychiatric tolerance. Adverse events were frequent but often benign. The average (±SD) rate of apomorphine was 3.15±1.71 mg/h and the oral dopaminergic treatment was decreased by 37.8%. DISCUSSION The results are consistent with the literature except for the lack of efficiency on motor fluctuations which may be due to the use of too small doses of apomorphine. This seems to be a leading cause of discontinuation of CAI, especially when it is associated with side effects or important constraints. For better efficiency on motor fluctuations, we recommend the use of apomorphine at higher doses to obtain an optimal continuous dopaminergic stimulation.
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Affiliation(s)
- M Rambour
- Service de neurologie et pathologie du mouvement, hôpital Roger-Salengro, CHRU de Lille, rue Émile-Laine, 59037 Lille cedex, France.
| | - C Moreau
- Service de neurologie et pathologie du mouvement, hôpital Roger-Salengro, CHRU de Lille, rue Émile-Laine, 59037 Lille cedex, France; EA 4559, université Lille Nord de France, hôpital Roger-Salangro, rue Émile-Laine, 59037 Lille cedex, France
| | - J Salleron
- EA 2694, service de biostatistiques, université Lille Nord de France, CHRU de Lille, rue Émile-Laine, 59037 Lille, France
| | - D Devos
- Service de neurologie et pathologie du mouvement, hôpital Roger-Salengro, CHRU de Lille, rue Émile-Laine, 59037 Lille cedex, France; EA 4559, université Lille Nord de France, hôpital Roger-Salangro, rue Émile-Laine, 59037 Lille cedex, France
| | - A Kreisler
- Service de neurologie et pathologie du mouvement, hôpital Roger-Salengro, CHRU de Lille, rue Émile-Laine, 59037 Lille cedex, France; Inserm, UMR 837, Team 6, JPArc, IRCL, 2, avenue Oscar-Lambret, 59037 Lille cedex, France
| | - E Mutez
- Service de neurologie et pathologie du mouvement, hôpital Roger-Salengro, CHRU de Lille, rue Émile-Laine, 59037 Lille cedex, France; Inserm, UMR 837, Team 6, JPArc, IRCL, 2, avenue Oscar-Lambret, 59037 Lille cedex, France
| | - C Simonin
- Service de neurologie et pathologie du mouvement, hôpital Roger-Salengro, CHRU de Lille, rue Émile-Laine, 59037 Lille cedex, France; Inserm, UMR 837, Team 6, JPArc, IRCL, 2, avenue Oscar-Lambret, 59037 Lille cedex, France
| | - A Annic
- Service de neurologie et pathologie du mouvement, hôpital Roger-Salengro, CHRU de Lille, rue Émile-Laine, 59037 Lille cedex, France
| | - K Dujardin
- Service de neurologie et pathologie du mouvement, hôpital Roger-Salengro, CHRU de Lille, rue Émile-Laine, 59037 Lille cedex, France; EA 4559, université Lille Nord de France, hôpital Roger-Salangro, rue Émile-Laine, 59037 Lille cedex, France
| | - A Destée
- Service de neurologie et pathologie du mouvement, hôpital Roger-Salengro, CHRU de Lille, rue Émile-Laine, 59037 Lille cedex, France; Inserm, UMR 837, Team 6, JPArc, IRCL, 2, avenue Oscar-Lambret, 59037 Lille cedex, France
| | - L Defebvre
- Service de neurologie et pathologie du mouvement, hôpital Roger-Salengro, CHRU de Lille, rue Émile-Laine, 59037 Lille cedex, France; EA 4559, université Lille Nord de France, hôpital Roger-Salangro, rue Émile-Laine, 59037 Lille cedex, France
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Annic A, Devos D, Seguy D, Dujardin K, Destée A, Defebvre L. [Continuous dopaminergic stimulation by Duodopa in advanced Parkinson's disease: Efficacy and safety]. Rev Neurol (Paris) 2009; 165:718-27. [PMID: 19150100 DOI: 10.1016/j.neurol.2008.11.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2008] [Revised: 09/03/2008] [Accepted: 11/17/2008] [Indexed: 11/25/2022]
Abstract
INTRODUCTION When advanced Parkinson's disease (PD) patients experience motor complications (fluctuations and dyskinesias) despite standard oral treatment, two treatment options are available: deep brain stimulation and subcutaneous apomorphine infusion with respects of indications for each strategy. Continuous intraduodenal infusion of levodopa (Duodopa) via a gastrojejunal tube may be proposed at this stage of the disease and the study of indications and clinical results with Duodopa may develop this new therapeutic alternative. PATIENTS AND METHODS Seven patients with advanced PD (dementia for all and psychiatric disorders for some of them, axial signs) were treated with Duodopa. We evaluated neuropsychological functions, all UPDRS scales, gait and quality-of-life just before Duodopa onset and six months after treatment end. Moreover, we described all adverse events (early and late) and studied daily levodopa doses before and 6 months after treatment. RESULTS We demonstrated an improvement in motor UPDRS (44%), in axial signs (40% for UPDRS part III axial subscore and 12% for gait) and a reduction of fluctuations (37.5%) and in UPDRS part IV dyskinesia (20%). These significant results are observed without any change in the quality-of-life. Adverse events were due to PEG positioning for four patients, the equipment (pump, connection, inner tube) for all patients and levodopa for four patients. Daily levodopa dose had to be increased 13.5%. CONCLUSION Duodopa can be considered as a new treatment strategy providing significant improvements in motor fluctuations, dyskinesia and severe axial signs. These results were demonstrated in very advanced PD patients, who had been excluded from previous studies, with cognitive disorders and for some of them dopaminergic psychosis well controlled by medications.
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Affiliation(s)
- A Annic
- EA, IFR, hôpital Roger-Salengro, centre hospitalier et universitaire de Lille, France
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