Department of Neurology, University Hospital, Service de Neurologie, CHU Pontchaillou, 2 rue Henri le Guilloux, 35033 Rennes Cedex, France.
Parkinsonism Relat Disord. 2012 Jan;18(1):40-4. doi: 10.1016/j.parkreldis.2011.08.010. Epub 2011 Sep 3.
The efficacy of continuous subcutaneous apomorphine infusion (APO) has been evaluated in advanced Parkinson's disease in several open-label studies but never in a population of patients for whom subthalamic nucleus deep brain stimulation (STN-DBS) was contraindicated.
The aim of this study was to evaluate the efficacy and cognitive safety of APO at 12-month follow-up in 23 advanced parkinsonian patients (mean age: 62.3 years; mean disease duration: 13.9 years) whose dopa-resistant axial motor symptoms and/or cognitive decline constituted contraindications for STN-DBS. Their motor and cognitive status were evaluated before APO and 12 months afterwards.
After one year, patients expressed high levels of satisfaction, with a mean rating on the Visual Analog Scale of 52.8% under APO. Daily OFF time, recorded in a 24-h diary, was reduced by 36% and ON time improved by 48%. There was a significant reduction (-26%) in mean oral levodopa equivalent dose. Dopa-resistant axial symptoms and neuropsychological performance remained stable. No adverse event was noted and none of the patients needed to take clozapine at any time.
APO is both safe and effective in advanced parkinsonian patients with untreatable motor fluctuations, for whom STN-DBS is contraindicated due to dopa-resistant axial motor symptoms and/or cognitive decline. As such, it should be regarded as a viable alternative for these patients.
连续皮下给予阿朴吗啡输注（APO）在几项开放性研究中已被评估用于晚期帕金森病，但从未在因丘脑底核深部脑刺激（STN-DBS）禁忌而不适合该治疗的患者群体中进行过评估。
本研究旨在评估在 23 例因多巴胺抵抗性轴性运动症状和/或认知下降而构成 STN-DBS 禁忌的晚期帕金森病患者（平均年龄：62.3 岁；平均病程：13.9 年）中，APO 在 12 个月随访时的疗效和认知安全性。在 APO 之前和之后 12 个月，评估了他们的运动和认知状况。
一年后，患者的满意度很高，APO 下的平均视觉模拟量表评分为 52.8%。24 小时日记记录的每日“关期”时间减少了 36%，“开期”时间增加了 48%。平均口服左旋多巴等效剂量减少了 26%。多巴胺抵抗性轴性症状和神经心理学表现保持稳定。未观察到不良事件，且无患者在任何时候需要服用氯氮平。
APO 在因多巴胺抵抗性轴性运动症状和/或认知下降而不适合 STN-DBS 的难治性运动波动的晚期帕金森病患者中既安全又有效。因此，应将其视为这些患者的可行替代治疗方法。
