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What is the best treatment for fluctuating Parkinson's disease: continuous drug delivery or deep brain stimulation of the subthalamic nucleus?

Hilker, Ruediger; Antonini, Angelo and Odin, Per LU (2011) In Journal of Neural Transmission 118(6). p.907-914
Abstract
Motor complications impair quality of life and cause severe disability in patients with advanced Parkinson's disease (PD). Since they are often refractory to medical therapy, interventional therapies have been developed, which can provide a considerable reduction of daily off-time and dopaminergic dyskinesias. Continuous dopaminergic drug delivery (CDD) is based on the steady stimulation of striatal dopamine receptors by subcutaneous apomorphine or duodenal l-DOPA infusions via portable minipumps. Advances in the understanding of basal ganglia functioning and in neurosurgical, electrophysiological and neuroimaging techniques have led to a renaissance of neurosurgery for advanced PD. Deep brain stimulation of the subthalamic nucleus... (More)
Motor complications impair quality of life and cause severe disability in patients with advanced Parkinson's disease (PD). Since they are often refractory to medical therapy, interventional therapies have been developed, which can provide a considerable reduction of daily off-time and dopaminergic dyskinesias. Continuous dopaminergic drug delivery (CDD) is based on the steady stimulation of striatal dopamine receptors by subcutaneous apomorphine or duodenal l-DOPA infusions via portable minipumps. Advances in the understanding of basal ganglia functioning and in neurosurgical, electrophysiological and neuroimaging techniques have led to a renaissance of neurosurgery for advanced PD. Deep brain stimulation of the subthalamic nucleus (STN-DBS) is the most invasive procedure promising great benefit and the highest level of independency for suitable patients, but is definitely associated with surgical risks and DBS-related side effects. Each of these more or less invasive therapy options has its own profile, and a thorough consideration of its advantages and drawbacks for the individual situation is mandatory. In this paper, we summarize relevant facts for this decision and provide some guidelines for a responsible counseling of eligible patients. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Apomorphine, Deep brain stimulation, Duodopa, Motor fluctuations, Parkinson's disease
in
Journal of Neural Transmission
volume
118
issue
6
pages
907 - 914
publisher
Springer
external identifiers
  • wos:000291062000008
  • scopus:80051665922
ISSN
0300-9564
DOI
10.1007/s00702-010-0555-8
language
English
LU publication?
yes
id
1da0ebf6-2c2d-4703-9437-258ee9ca4a48 (old id 1985899)
date added to LUP
2011-07-06 11:50:43
date last changed
2017-11-12 03:49:03
@article{1da0ebf6-2c2d-4703-9437-258ee9ca4a48,
  abstract     = {Motor complications impair quality of life and cause severe disability in patients with advanced Parkinson's disease (PD). Since they are often refractory to medical therapy, interventional therapies have been developed, which can provide a considerable reduction of daily off-time and dopaminergic dyskinesias. Continuous dopaminergic drug delivery (CDD) is based on the steady stimulation of striatal dopamine receptors by subcutaneous apomorphine or duodenal l-DOPA infusions via portable minipumps. Advances in the understanding of basal ganglia functioning and in neurosurgical, electrophysiological and neuroimaging techniques have led to a renaissance of neurosurgery for advanced PD. Deep brain stimulation of the subthalamic nucleus (STN-DBS) is the most invasive procedure promising great benefit and the highest level of independency for suitable patients, but is definitely associated with surgical risks and DBS-related side effects. Each of these more or less invasive therapy options has its own profile, and a thorough consideration of its advantages and drawbacks for the individual situation is mandatory. In this paper, we summarize relevant facts for this decision and provide some guidelines for a responsible counseling of eligible patients.},
  author       = {Hilker, Ruediger and Antonini, Angelo and Odin, Per},
  issn         = {0300-9564},
  keyword      = {Apomorphine,Deep brain stimulation,Duodopa,Motor fluctuations,Parkinson's disease},
  language     = {eng},
  number       = {6},
  pages        = {907--914},
  publisher    = {Springer},
  series       = {Journal of Neural Transmission},
  title        = {What is the best treatment for fluctuating Parkinson's disease: continuous drug delivery or deep brain stimulation of the subthalamic nucleus?},
  url          = {http://dx.doi.org/10.1007/s00702-010-0555-8},
  volume       = {118},
  year         = {2011},
}