Continuous apomorphine infusion and neuropsychiatric disorders: a controlled study in patients with advanced Parkinson's disease
ABSTRACT The aim of this study was to assess whether patients with Parkinson's disease (PD) develop cognitive and psychiatric complications more frequently during prolonged therapy with continuous apomorphine infusion compared with standard oral treatment. Thirty consecutive PD patients with severe motor fluctuations were included in the study. Twelve patients accepted the treatment with subcutaneous continuous apomorphine infusion, while the remaining 18 preferred to continue with oral dopaminergic therapy. The two groups were evaluated with neuropsychological, psychiatric, and motor tests at baseline and after 1 year. The off daily duration and the levodopa dosage were significantly reduced in infused patients. The neuropsychiatric assessment did not change in both groups compared with baseline, except for a significant improvement of mood in the apomorphine group.
Full-textDOI: · Available from: Giorgio Basile, Jul 28, 2015
- SourceAvailable from: Christofer Lundqvist
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- "Despite these side-effects, the treatment has been demonstrated to give a lasting improvement of dyskinesias and to reduce off-time signifi cantly (Colzi et al 1998; Stocchi et al 2001; Kanovsky et al 2002). In studies evaluating long-term treatment, no worsening of neuropsychiatric parameters has been described (Di Rosa et al 2003). Dosage of levodopa can be considerably reduced without loss of symptom control but some levodopa usually must be maintained (Colzi et al 1998; Stocchi et al 2001). "
ABSTRACT: Parkinson's disease is characterized by the progression of the disease from the early stages where it still has little functional consequence for afflicted patients, to an advanced stage disease with large consequences in terms of function, quality of life and individual and societal costs. Motor fluctuations and symptoms of levodopa overdosage may occur in parallel with increasing Parkinsonian symptoms. This leads to a narrower therapeutic window which causes problems with traditional oral medication. Various ways of optimizing oral treatment should be tried but often have limited effects. In addition to the previous alternatives of neurosurgery (especially deep brain stimulation of the subthalamic nuclei) and continuous apomorphine treatment there is now also the alternative of continuous enteral levodopa administration via a trans-abdominal tube. The effect of the treatment may be tested individually via naso-duodenal administration before a decision is made whether to continue with permanent treatment. In the present article, the challenges to treatment of Parkinson's disease in these phases are described as well as the various treatment alternatives available. Focus is mainly on the clinical studies of continuous levodopa infusion therapies, especially enteral administration of levodopa/carbidopa gel. The place of enteral levodopa/carbidopa gel treatment among the other treatment methods is also discussed.Neuropsychiatric Disease and Treatment 07/2007; 3(3):335-48. · 2.15 Impact Factor
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ABSTRACT: The Dispenser Cathode Life Model (DCLM) was originally published in 1984. More recent life test data have substantiated the basic physics used in the DCLM. Re-evaluation of the model with this newer data alters primarily the numerical parameters but not the basic physics of the model. One modification made to the model is to incorporate the shape factor α in the emission equation so that accurate descriptions of the cathode activity curves can be made (this is necessary because cathode activity as a function of age was taken along with cathode current Ik at the operating point). The original model was fitted to I <sub>k</sub>(t) life test data at the operating point for cathodes running at different temperatures. This revision fits the cathode activity curves (i.e. current vs. temperature) as a function of time and as a function of operating temperature. Cathode current versus temperature is one step closer to the underlying physics and gives a better measure of how the internal parameters, such as work function and knee position and shape, change with time. Knowing these details gives a better measure of how the cathode current at the operating point will change over timeVacuum Electronics Conference, 2000. Abstracts. International; 02/2000