Abstract
BackgroundSubthalamic Deep Brain Stimulation (DBS) have demonstrated in the last decades to determine an important clinical improvement in advanced and selected Parkinson’s disease (PD) patients. However, only a minority of parkinsonian patients meet the criteria to undergo DBS, and the surgical procedure itself is often stressful, especially for patients experiencing severe OFF state. Subcutaneous Apomorphine continuous administration is suitable as an adjunctive therapy capable of improving a suboptimal DBS result. Here we hypothesize a possible role for subcutaneous apomorphine infusion to alleviate severe OFF state in parkinsonian patients undergoing DBS, thus allowing intraoperative microrecording and patient’s collaboration during clinical testing.Case presentationA 68-year-old man, suffering from a very long PD-history, characterized by a severe akinetic status and dramatic non-motor features while in OFF, underwent Subthalamic-DBS keeping a slight but continuous apomorphine infusion (1.8 mg/hour), able to guarantee the right degree of patient’s collaboration without interfering with microelectrode recordings. There were no intra or perioperative complications and after the procedure he experienced a marked clinical benefit, being able to stop apomorphine administration.ConclusionsHere we described the first Subthalamic DBS procedure performed with a low and stable dopaminergic stimulation guaranteed by subcutaneous Apomorphine continuous infusion. For its rapidity of action and prompt reversibility, apomorphine could be particularly suitable for use during difficult surgical procedures in PD, allowing more therapeutic opportunities for patients who would otherwise be excluded from the DBS option.
Highlights
Subthalamic Deep Brain Stimulation (DBS) have demonstrated in the last decades to determine an important clinical improvement in advanced and selected Parkinson’s disease (PD) patients
The efficacy of continuous subcutaneous apomorphine infusion (APO), and intrajejunal levodopa infusion has been established as well, and with STN-DBS, they are generally considered as options for advanced Parkinson’s disease (a-PD)
APO in the perioperative DBS period can have a role, as in the case we describe, to enable awake surgery in a subject suffering from a very severe parkinsonian condition
Summary
Subthalamic Deep Brain Stimulation (DBS) have demonstrated in the last decades to determine an important clinical improvement in advanced and selected Parkinson’s disease (PD) patients. Background among device-aided therapies for advanced Parkinson’s disease (a-PD), Subthalamic Deep Brain Stimulation (STN-DBS) has the advantage to be a one-time procedure generally determining a good, long-lasting, clinical efficacy [1]. Perrino’s Hospital, strada statale 7 per Mesagne, 72100 Brindisi, Italy Full list of author information is available at the end of the article that the anatomic target is further refined by electrophysiological mapping and that intraoperative stimulation defines the therapeutic window of a selected track, trying to avoid unacceptably low side-effect threshold with stimulation.
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