Apomorphine subcutaneous infusion, duodenal infusion of levodopa and deep brain stimulation – three advanced treatment options for the advanced Parkinson’s disease

  • Dušan Flisar University Clinical Center Ljubljana Neurology Clinic
  • Nina Zupančič Križnar University Clinical Center Ljubljana Neurology Clinic
  • Maja Trošt University Clinical Center Ljubljana Neurology Clinic
  • Zvezdan Pirtošek University Clinical Center Ljubljana Neurology Clinic
DOI: https://doi.org/10.6016/ZdravVestn.1402
Keywords: Parkinson’s disease, apomorphine subcutaneous infusion, duodenal infusion of levodopa, deep brain stimulation

Abstract

Advanced stage of Parkinson's disease is associated with motor complications: motor fluctuations and dyskinesias. The disease can no longer be satisfactorily treated with oral therapy that is based on treatment with levodopa. Dying of dopamine neurons, a short half-life of levodopa and pulsatile stimulation of dopamine receptors are the main reasons for these complications. Currently, there are three options available to treat the advanced stage of Parkinson's disease: subcutaneous infusion of apomorphine, intrajejunal infusion of levodopa and deep brain stimulation. It is necessary to choose the optimal method of treatment that is most suitable for the individual patient.

Downloads

Download data is not yet available.

Author Biographies

Dušan Flisar, University Clinical Center Ljubljana Neurology Clinic
Dušan Flisar, MD
Nina Zupančič Križnar, University Clinical Center Ljubljana Neurology Clinic
Nina Zupančič Križnar, MD
Maja Trošt, University Clinical Center Ljubljana Neurology Clinic
Assist. Prof. Maja Trošt, MD, PhD
Zvezdan Pirtošek, University Clinical Center Ljubljana Neurology Clinic
Prof. Zvezdan Pirtošek, MD, PhD

References

Olanow CW. Te pathogenesis of cell death in Parkinson’s disease—2007. Mov Disord. 2007; 22 suppl 17: 335–42.

Nutt JG, Woodward WR, Hammerstad JP, Carter JH, Anderson JL. Te »on-off« phenomenon in Parkinson’s disease. Relation to levodopa absorption and transport. N Engl J Med. 1984; 310: 483–8.

Chase TN. Levodopa therapy: consequences of the nonphysiologic replacement of dopamine. Neurology. 1998; 50 suppl 5: 17–25.

Cenci MA, Andersson M, Daniel SE, Kingsbury AE, Kliford L, Lees AJ. Striatal expression of FosB-related transcription factors in human Parkinsonn’s disease. Relation to L dopa induced dyskinesias. Mov Disord. 2002; 17 suppl 5: 98.

Olanow CW, Obeso JA. Preventing levodopa-induced dyskinesias. Ann Neurol. 2000; 47 suppl 1: 167–78.

Factor SA, Brown DL, Molho ES. Subcutaneous apomorphine injections as a treatment for intractable pain in Parkinson’s disease. Mov Disord. 2000; 15: 167–9.

Factor SA. Literature review: intermittent subcutaneous apomorphine therapy in Parkinson’s disease. Neurology. 2004; 62 suppl 4: 12–7.

Gancher S. Pharmacokinetics of apomorphine in Parkinson’s disease. J Neural Transm Suppl. 1995; 45: 137–41.

Sam E, Jeanjean AP, Maloteaux JM, Verbeke N. Apomorphine pharmacokinetics in parkinsonism afer intranasal and subcutaneous application. Eur J Drug Metab Pharmacokinet. 1995; 20: 27–33.

Chen JJ, Obering C. A review of intermittent subcutaneous apomorphine injections for the rescue management of motor fluctuations associated with advanced Parkinson’s disease. Clin Ter. 2005; 27: 1710–24.

Trosch RM, Silver D, Bottini PB. Intermittent subcutaneous apomorphine therapy for ‘off ’ episodes in Parkinson’s disease: a 6-month open-label study. CNS Drugs. 2008; 22: 519–27.

LeWitt PA, Ondo WG, Van Lunen B, Bottini PB. Open-label study assessment of safety and adverse effects of subcutaneous apomorphine injections in treating »off« episodes in advanced Parkinson disease. Clin Neuropharmacol. 2009; 2: 89–93.

Pietz K, Hagell P, Odin P. Subcutaneous apomorphine in late stage Parkinson’s disease: a long term follow up. J Neurol Neurosurg Psychiatry. 1998; 65: 709–16.

O’Sullivan JD, Lees AJ. Use of apomorphine in Parkinson’s disease. Hospital Medicine. 1999; 60: 816–20.

García Ruiz PJ, Sesar Ignacio A, Ares Pensado B, Castro García A, Alonso Frech F, Alvarez Lopez M, et al. Efcacy of long-term continuous subcutaneous apomorphine infusion in advanced Parkinson’s disease with motor fluctuations: a multicenter study. Mov Disord. 2008; 23: 1130–6.

Deleu D, Hanssens Y, Northway MG. Subcutaneous apomorphine: an evidence-based review of its use in Parkinson’s disease. Drugs Aging. 2004; 21: 687–709.

Colzi A, Turner K, Lees AJ. Continuous subcutaneous waking day apomorphine in the long term treatment of levodopa induced interdose dyskinesias in Parkinson’s disease. J Neurol Neurosurg Psychiatry. 1998; 64: 573–6.

Manson AJ, Turner K, Lees AJ. Apomorphine monotherapy in the treatment of refractory motor complications of Parkinson’s disease: long-term follow-up study of 64 patients. Mov Disord. 2002; 17: 1235–41.

De Gaspari D, Siri C, Landi A, Cilia R, Bonetti A, Natuzzi F, et al. Clinical and neuropsychological follow up at 12 months in patients with complicated Parkinson’s disease treated with subcutaneous apomorphine infusion or deep brain stimulation of the subthalamic nucleus. J Neurol Neurosurg Psychiatry. 2006; 77: 450–3.

Haq IU, Lewitt PA, Fernandez HH. Apomorphine therapy in Parkinson’s disease: a review. Expert Opin Pharmacother. 2007; 8: 2799–809.

Hardie RJ, Lees AJ, Stern GM. On-off response. Clinical and biochemical correlations during oral and intravenous levodopa administration in parkinsonian patients. Neurology. 1975; 25: 1144–8.

Hardie RJ, Lees AJ, Stern GM. On-off fluctuations in Parkinson’s disease. A clinical and neuropharmacological study. Brain. 1984; 107: 487–506.

Nyholm D. Enteral levodopa/carbidopa gel infusion for the treatment of motor fluctuations and dyskinesias in advanced Parkinson’s disease. Expert Rev Neurother. 2006; 6: 1403–11.

Nyholm D, Nilsson Remahl AI, Dizdar N, Constantinescu R, Holmberg B, Jansson R et al. Duodenal levodopa infusion monotherapy vs oral polypharmacy in advanced Parkinson disease. Neurology. 2005; 64: 216–23.

Antonini A, Isaias IU, Canesi M, Zibetti M, Mancini F, Manfredi L et al. Duodenal levodopa infusion for advanced Parkinson’s disease: 12-month treatment outcome. Mov Disord. 2007; 22: 1145–9.

Agid Y, Al Khedr A, Annic A, Azulay JP, Bakchine S, Barroche G, et al; French DUODOPA Study Group. Patient profle, indications, efcacy and safety of duodenal levodopa infusion in advanced Parkinson’s disease. Mov Disord. 2009; 24: 993–1000.

Fernandez HH, Vanagunas A, Odin P, Espay AJ, Hauser RA, Standaert DG, et al. Levodopa-carbidopa intestinal gel in advanced Parkinson’s disease open-label study: interim results. Parkinsonism Relat Disord. 2013; 19: 339–45.

Olanow CW, Kieburtz K, Odin P, Espay AJ, Standaert DG, Fernandez HH, et al; LCIG Horizon Study Group. Continuous intrajejunal infusion of levodopa-carbidopa intestinal gel for patients with advanced Parkinson’s disease: a randomized, controlled, double-blind, double-dummy study. Lancet Neurol. 2014; 13: 141–9.

Eggert K, Schrader C, Hahn M, Stamelou M, Rüssmann A, Dengler R, et al. Continuous jejunal levodopa infusion in patients with advanced Parkinson’s disease: practical aspects and outcome of motor and non-motor complications. Clin Neuropharmacol. 2008; 31: 151–66.

Honig H, Antonini A, Martinez-Martin P, Forgacs I, Faye GC, Fox T, et al. Intrajejunal levodopa infusion in Parkinson’s disease: a pilot multicenter study of effects on non-motor symptoms and quality of life. Mov Disord. 2009; 24: 1468–74.

Fasano A, Ricciardi L, Lena F, Bentivoglio AR, Modugno N. Intrajejunal levodopa infusion in advanced Parkinson’s disease: long-term effects on motor and non-motor symptoms and impact on patients and caregivers quality of life. Eur Rev Med Pharmacol Sci. 2012; 16: 79–89.

Nyholm D, Klangemo K, Johansson A. Levodopa/carbidopa intestinal gel infusion long-term therapy in advanced Parkinson’s disease. Eur J Neurol. 2012; 19: 1079–85.

Klostermann F, Jugel C, Mueller T, Marzinzik P. Malnutritional neuropathy under intestinal levodopa infusion. J Neural Transm. 2012; 119: 369–72.

Santos-García D, de la Fuente-Fernández R, Valldeoriola F, Palasí A, Carrillo F, Grande M et al. Polyneuropathy while on duodenal levodopa infusion in Parkinson’s disease patients: we must be alert. J Neurol. 2012; 259: 1668–72.

Hornykiewicz O. A brief history of levodopa. J Neurol. 2010; 257 suppl 2: 249–52.

Laitinen LV, Bergenheim AT, Hariz MI. Ventroposterolateral pallidotomy can abolish all parkinsonian symptoms. Stereotact Funct Neurosurg. 1992; 58: 14–21.

Aziz TZ, Peggs D, Sambrook MA, Crossman AR. Lesion of the subthalamic nucleus for the alleviation of 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP)-induced parkinsonism in the primate. Mov Disord. 1991; 6: 288–92.

Bergman H, Wichmann T, DeLong MR. Reversal of experimental parkinsonism by lesions of the subthalamic nucleus. Science. 1990; 249: 1436–8.

Benabid AL, Pollak P, Louveau A, Henry S, de Rougemont J. Combined (thalamotomy and stimulation) stereotactic surgery of the VIM thalamic nucleus for bilateral Parkinson disease. Appl Neurophysiol. 1987; 50: 344–6.

Benabid AL, Benazzouz A, Hoffmann D, Limousin P, Krack P, Pollak P. Long-term electrical inhibition of deep brain targets in movement disorders. Mov Disord. 1998; 13 suppl 3: 119–25.

Benazzouz A, Hallett M. Mechanism of action of deep brain stimulation. Neurology. 2000; 55 suppl 6: 13–6.

Lang AE, Widner H. Deep brain stimulation for Parkinson’s disease: patient selection and evaluation. Mov Disord. 2002; 17 suppl 3: 94–101.

Krack P, Batir A, Van Blercom N, Chabardes S, Fraix V, Ardouin C, et al. Five-year follow-up of bilateral stimulation of the subthalamic nucleus in advanced Parkinson’s disease. N Engl J Med. 2003; 349: 1925–34.

Zibetti M, Pesare M, Cinquepalmi A, Rosso M, Bergamasco B, Ducati A, et al. Antiparkinsonian therapy modifcations in PD patients afer STN DBS: a retrospective observational analysis. Parkinsonism Relat Disord. 2008; 14: 608–12.

Davis JT, Lyons KE, Pahwa R. Freezing of gait after bilateral subthalamic nucleus stimulation for Parkinson’s disease. Clin Neurol Neurosurg. 2006; 108: 461–4.

Zibetti M, Torre E, Cinquepalmi A, Rosso M, Ducati A, Bergamasco B, et al. Motor and nonmotor symptom follow-up in parkinsonian patients afer deep brain stimulation of the subthalamic nucleus. Eur Neurol. 2007; 58: 218–23.

Romito LM, Albanese A. Dopaminergic therapy and subthalamic stimulation in Parkinson’s disease: a review of 5-year reports. J Neurol. 2010; 257 suppl 2: 298–304.

Kleiner-Fisman G, Herzog J, Fisman DN, Tamma F, Lyons KE, Pahwa R, et al. Subthalamic nucleus deep brain stimulation: summary and meta-analysis of outcomes. Mov Disord. 2006; 2 suppl 14: 290–304.

Schuepbach WM, Rau J, Knudsen K, Volkmann J, Krack P, Timmermann L, et al. Neurostimulation for Parkinson’s disease with early motor complications. N Engl J Med. 2013; 368: 610–22.

Mestre TA, Espay AJ, Marras C, Eckman MH, Pollak P, Lang AE. Subthalamic nucleus-deep brain stimulation for early motor complications in Parkinson’s disease-the EARLYSTIM trial: early is not always better. Mov Disord. 2014; 29: 1751–6.

Witt K, Daniels C, Reiff J, Krack P, Volkmann J, Pinsker MO, et al. Neuropsychological and psychiatric changes afer deep brain stimulation for Parkinson’s disease: a randomised, multicentre study. Lancet Neurol. 2008; 7: 605–14.

Hariz MI, Rehncrona S, Quinn NP, Speelman JD, Wensing C; Multicentre Advanced Parkinson’s Disease Deep Brain Stimulation Group. Multicenter study on deep brain stimulation in Parkinson’s disease: an independent assessment of reported adverse events at 4 years. Mov Disord. 2008; 23: 416–21.

Okun MS, Gallo BV, Mandybur G, Jagid J, Foote KD, Revilla FJ, et al. Subthalamic deep brain stimulation with a constant-current device in Parkinson’s disease: an open-label randomised controlled trial. Lancet Neurol. 2012; 11: 140–9.

Voon V, Krack P, Lang AE, Lozano AM, Dujardin K, Schupbach M, et al. A multicentre study on suicide outcomes following subthalamic stimulation for Parkinson’s disease. Brain. 2008; 131: 2720–8.

Trošt M. Globoka možganska stimulacija. In: Trošt M, ed. Kontinuirana zdravljenja parinsonove bolezni. 21. Klub bazalni gangliji; 2015 april 9 ; Ljubljana, Slovenija. Ljubljana: UKCLJ, Nevrološka klinika, Klinični oddelek za bolezni živčevja; 2015.

Antonini A, Tolosa E. Apomorphine and levodopa infusion therapies for advanced Parkinson’s disease: selection criteria and patient management. Expert Rev Neurother. 2009; 9: 859–67.

Hilker R, Antonini A, Odin P. What is the best treatment for fluctuating Parkinson’s disease: continuous drug delivery or deep brain stimulation of the subthalamic nucleus? J Neural Transm. 2011; 118: 907–14.

Antonini A, Odin P. Pros and cons of apomorphine and L-dopa continuous infusion in advanced Parkinson’s disease. Parkinsonism Relat Disord. 2009; 15 suppl 4: 97–100.

Flisar D. Apomorfn v zdravljenju parkinsonove bolezni. In: Trošt M, ed. Kontinuirana zdravljenja parinsonove bolezni. 21. Klub bazalni gangliji; 2015 april 9 ; Ljubljana, Slovenija. UKCLJ, Nevrološka klinika, Klinični oddelek za bolezni živčevja; 2015.

Zupančič N. Intrajejunalna infuzija gela levodope. In: Trošt M, ed. Kontinuirana zdravljenja parinsonove bolezni. 21. Klub bazalni gangliji; 2015 april 9 ; Ljubljana, Slovenija. UKCLJ, Nevrološka klinika, Klinični oddelek za bolezni živčevja; 2015.

Published
2016-08-29
How to Cite
1.
Flisar D, Zupančič Križnar N, Trošt M, Pirtošek Z. Apomorphine subcutaneous infusion, duodenal infusion of levodopa and deep brain stimulation – three advanced treatment options for the advanced Parkinson’s disease. TEST ZdravVestn [Internet]. 29Aug.2016 [cited 27Apr.2024];85(7-8). Available from: http://vestnik-dev.szd.si/index.php/ZdravVest/article/view/1402
Issue
Vol 85 No 7-8 (2016): July-August
Section
Review


The Author transfers to the Publisher (Zdravniški vestnik/Slovenian Medical Journal) all economic copyrights following form Article 22 of the Slovene Copyright and Related Rights Act (ZASP), including the right of reproduction, the right of distribution, the rental right, the right of public performance, the right of public transmission, the right of public communication by means of phonograms and videograms, the right of public presentation, the right of broadcasting, the right of rebroadcasting, the right of secondary broadcasting, the right of communication to the public, the right of transformation, the right of audiovisual adaptation and all other rights of the author according to ZASP.

The aforementioned rights are transferred non-exclusively, for an unlimited number of editions, for the term of the statutory

The Author can make use of his work himself or transfer subjective rights to others only after 3 months from date of first publishing in the journal Zdravniški vestnik/Slovenian Medical Journal.

The Publisher (Zdravniški vestnik/Slovenian Medical Journal) has the right to transfer the rights, acquired parties without explicit consent of the Author.

The Author consents that the Article be published under the Creative Commons BY-NC 4.0 (attribution-non-commercial) or comparable licence.