Comparative cognitive effects of bilateral subthalamic stimulation and subcutaneous continuous infusion of apomorphine in Parkinson's disease

Alegret, Montserrat; Valldeoriola, Francesc; Martí, Miquel; Pilleri, Manuela; Junqué, Carme; Rumià, Jordi; Tolosa, Eduardo

doi:10.1002/mds.20237

Cited by 81 publications

(69 citation statements)

References 31 publications

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“…Specific cognition deficits include impairments of working memory (Saint-Cyr et al, 2000;Higginson et al, 2009;Okun et al, 2009), cognitive processing, visuo-spatial skills and setshifting (Saint-Cyr et al, 2000;Alegret et al, 2001), response inhibition (Witt et al, 2004), or the decoding of facial expressions (Dujardin et al, 2004;Schroeder et al, 2004;Biseul et al, 2005;Drapier et al, 2008). Even when present, the impact of changes in verbal fluency on the quality of life appears to be relatively small (Alegret et al, 2004;Morrison et al, 2004;Montel and Bungener, 2009;Zahodne et al, 2009). Although almost half patients with DBS experience variable degrees of cognitive changes (Higginson et al, 2009), these deficits become 'relevant' in less than 10% treated patients (Castelli et al, 2006;Tir et al, 2007).…”

Section: Non-motor Side Effects Of Stn and Gpi-dbsmentioning

confidence: 99%

Parkinson's Disease Therapeutics: New Developments and Challenges Since the Introduction of Levodopa

Smith

Wichmann

Factor

et al. 2011

Neuropsychopharmacol

194

137

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The demonstration that dopamine loss is the key pathological feature of Parkinson's disease (PD), and the subsequent introduction of levodopa have revolutionalized the field of PD therapeutics. This review will discuss the significant progress that has been made in the development of new pharmacological and surgical tools to treat PD motor symptoms since this major breakthrough in the 1960s. However, we will also highlight some of the challenges the field of PD therapeutics has been struggling with during the past decades. The lack of neuroprotective therapies and the limited treatment strategies for the nonmotor symptoms of the disease (ie, cognitive impairments, autonomic dysfunctions, psychiatric disorders, etc.) are among the most pressing issues to be addressed in the years to come. It appears that the combination of early PD nonmotor symptoms with imaging of the nigrostriatal dopaminergic system offers a promising path toward the identification of PD biomarkers, which, once characterized, will set the stage for efficient use of neuroprotective agents that could slow down and alter the course of the disease.

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Section: Non-motor Side Effects Of Stn and Gpi-dbsmentioning

confidence: 99%

Parkinson's Disease Therapeutics: New Developments and Challenges Since the Introduction of Levodopa

Smith

Wichmann

Factor

et al. 2011

Neuropsychopharmacol

194

137

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“…Assessment of turning on the stimulator improved executive function, but worsened conditional associative and visual conditional learning (Jahanshahi et al., 2000; Pillon et al., 2000). A study comparing the effects on cognition of STN‐DBS and subcutaneous continuous infusion of apomorphine (APM‐CSI) showed that, contrary to APM‐CSI, STN‐DBS produced a worsening in executive functions (Alegret et al., 2004). Functional neuroimaging studies showed that frontal tasks either did not recover or worsened after STN‐DBS over time (Kalbe et al., 2009).…”

Section: Introductionmentioning

confidence: 99%

l‐Dopa/carbidopa intestinal gel and subthalamic nucleus stimulation: Effects on cognition and behavior

et al. 2017

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ObjectiveIn Parkinson's disease (PD), effects on behavior and cognition of levodopa/carbidopa intestinal gel (LCIG) and subthalamic stimulation (STN‐DBS) and their practical consequences remain controversial. This study was designed to analyze the possible effects of these therapies on cognition and behavior after 1 year follow‐up.MethodsThis was an open‐label, nonrandomized prospective study for pre‐ and postintervention analyses. Twenty‐four patients were considered eligible to be candidates for complex therapies such as STN‐DBS or LCIG; 23 patients treated with standard medication were included as controls. Several cognitive, behavioral, and motor scales were administered before and at 6 and 12 months after the intervention.ResultsPatients treated with LCIG experienced significant improvement in specific neuropsychological functions when compared with patients receiving STN‐DBS and conventional medical treatment after 1 year from the onset of the intervention. In this study, no significant cognitive or behavioral changes occurred in patients treated with subthalamic stimulation when compared to patients receiving conventional medical treatment at 1 year follow‐up.ConclusionsPatients treated with LCIG may significantly improve some specific neuropsychological functions when compared with patients receiving STN‐DBS and with patients receiving conventional medical treatment after 1 year from the intervention; there are not significant cognitive or behavioral changes in patients treated with STN‐DBS when compared to PD patients receiving conventional medical treatment after 1 year from the intervention. The outcomes showed in the study can help to the selection of the appropriate candidates for STN‐DBS and LCIG.

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“…In patients on APO therapy who develop numerous skin reactions, a change to LCIG therapy can be considered. Compared to DBS, APO infusion similarly decreases 'off' time, but not dyskinesias, according to two one-year studies 26,30 and a five-year prospective study. 32 A similar result was seen in a retrospective analysis of LCIG and DBS, but the DBS group was examined stimulation-on/medication-off, which could explain the difference in dyskinesias.…”

Section: Head-to-head Comparisonsmentioning

confidence: 96%

“…[15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32] The general finding is that APO provides more time in motor states near normal performance and less time in 'off' and dyskinetic states as compared to conventional optimised therapy. Improvement in quality of life (QoL) may accompany the increased 'on' time, but so far publications on this aspect of APO infusion are sparse.…”

Section: Long-term Efficacy With Apomorphine Infusionmentioning

confidence: 99%

Long-term Efficacy and Safety with Continuous Dopaminergic Stimulation Pump Treatments in Parkinson’s Disease

Busk¹,

Johansson²,

Nyholm³

2011

European Neurological Review

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Continuous dopaminergic stimulation (CDS) is important for symptom control in advanced stages of Parkinson's disease (PD). The most efficacious approaches are pump treatments with dopaminergic drugs: subcutaneous infusion of the dopamine receptor agonist apomorphine and intestinal infusion of levodopa/carbidopa gel. Both methods decrease motor fluctuations in long-term follow-ups, including parkinsonian and dyskinetic states, when compared to conventional optimised oral therapy. Also non-motor symptoms may be improved. Adverse drug reactions are usually less pronounced although high levodopa doses, which are common with levodopa/carbidopa infusion, may cause hyperhomocysteinaemia and cobalamin deficiency. Technical complications are specific for each infusion strategy. Formation of subcutaneous nodules is the most common problem with apomorphine infusion. Dislocation of the intestinal tube is the most common problem with levodopa/carbidopa infusion. Both pump treatments may be used for 24-hour infusion in selected patients. The long-term experience is reviewed. To conclude, CDS pump treatments may be successfully used for several years in advanced PD. KeywordsApomorphine, continuous dopaminergic stimulation, infusion, levodopa/carbidopa, Parkinson's disease, pump The background is a combination of a number of findings, mainly that:• striatal dopaminergic stimulation is fairly constant in a healthy brain;• striatal dopaminergic stimulation in PD is pulsatile when oral levodopa is used; • pulsatile dopaminergic stimulation causes motor fluctuations and dyskinesias; and • continuous administration of dopaminergic agents may decrease motor fluctuations and reverse dyskinesias.PD is associated with a more widespread pathology than nigro-striatal degeneration and CDS is not the remedy for all problems. But there is firm evidence that continuous dopaminergic drug delivery, probably providing CDS, produces a significant benefit compared to conventional therapy in patients with advanced PD. The evidence mainly stems from studies of levodopa and apomorphine infusions.

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Comparative cognitive effects of bilateral subthalamic stimulation and subcutaneous continuous infusion of apomorphine in Parkinson's disease

Cited by 81 publications

References 31 publications

Parkinson's Disease Therapeutics: New Developments and Challenges Since the Introduction of Levodopa

Parkinson's Disease Therapeutics: New Developments and Challenges Since the Introduction of Levodopa

l‐Dopa/carbidopa intestinal gel and subthalamic nucleus stimulation: Effects on cognition and behavior

Long-term Efficacy and Safety with Continuous Dopaminergic Stimulation Pump Treatments in Parkinson’s Disease

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