Selecting deep brain stimulation or infusion therapies in advanced Parkinson's disease: an evidence-based review.

Abstract

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.

• Authors: Jens Volkmann, Alberto Albanese, Angelo Antonini, K Ray Chaudhuri, Carl E Clarke, Rob M A de Bie, Günther Deuschl, Karla Eggert, Jean-Luc Houeto, Jaime Kulisevsky, Dag Nyholm, Per Odin, Karen Østergaard, Werner Poewe, Pierre Pollak, Jose Martin Rabey, Olivier Rascol, Evzen Ruzicka, Michael Samuel, Hans Speelman, Olof Sydow, Francesc Valldeoriola, Chris van der Linden, Wolfgang Oertel
• Journal: Journal of neurology (J Neurol) Vol. 260 Issue 11 Pg. 2701-14 (Nov 2013) ISSN: 1432-1459 [Electronic] Germany
• PMID: 23287972 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't, Review)

Chemical References

• Antiparkinson Agents
• Levodopa
• Carbidopa
• Apomorphine

Topics

• Antiparkinson Agents (administration & dosage)
• Apomorphine (administration & dosage)
• Carbidopa (administration & dosage)
• Deep Brain Stimulation
• Drug Administration Routes
• Evidence-Based Practice
• Humans
• Levodopa (administration & dosage)
• Parkinson Disease (therapy)