Abstract
Parkinson's disease (PD), a neurodegenerative disorder, is caused due to the loss of dopaminergic neurons in substantia nigra pars compacta, and it mainly affects the motor function of the diseased individual. The most effective treatment for PD to date is levodopa, the precursor molecule for dopamine which ultimately helps overcome the loss of dopamine in the brain. However, long-term levodopa therapy significantly impairs patients' quality of life by causing various disabling motor and non-motor complications. We conducted this study intending to review the available literature that has compared the efficacy and safety of continuous subcutaneous apomorphine infusion (CSAI) with other available treatment options like deep brain stimulation, intestinal levodopa gel, and oral dopaminergic agents. We searched PubMed, Embase, and Scopus databases using the appropriate search strategy. The studies which compared the safety and efficacy of continuous subcutaneous apomorphine infusion to other available treatment options in advanced Parkinson’s disease were included in our study. The bias assessment of the studies was done using Cochrane Risk of Bias 2.0 tool for randomized controlled trials, Risk of Bias In Non-Randomized Studies - of Interventions (ROBINS-I) tool for non-randomized interventional studies, and Joanna Briggs Institute Critical Appraisal tools (JBI) for cohort studies. We included eight articles in our systematic review including a randomized controlled trial. None of the included studies had a high risk of bias. We found that in patients with advanced Parkinson’s, CSAI demonstrated definite improvement in off-time duration. CSAI has also been shown to improve various non-motor functions, including neuropsychiatric problems in these patients. CSAI has demonstrated safety and efficacy in patients with advanced Parkinson’s disease. However, the decision-making is multifactorial. Hence, further studies are required that directly compare the available treatment options with one another and study their overall effects on patients’ quality of life.
Highlights
BackgroundParkinson's disease (PD) is a progressive neurodegenerative movement disorder caused by the loss of dopaminergic neurons from the substantia nigra pars compacta, which is located in the midbrain
This study is the first review to compare among Parkinson's disease patients the efficacy and safety of continuous subcutaneous apomorphine infusion (CSAI) with placebo and other conventional treatment modalities such as STN-DBS or levodopa
PD is a neurodegenerative disorder characterized by resting tremor, bradykinesia or akinesia, rigidity, and postural
Summary
Parkinson's disease (PD) is a progressive neurodegenerative movement disorder caused by the loss of dopaminergic neurons from the substantia nigra pars compacta, which is located in the midbrain. PD is characterized by resting tremor, bradykinesia or akinesia, rigidity, and postural instability [3] Apart from these symptoms, the other clinical manifestations of Parkinson's disease are motor symptoms such as hypomimia, dysarthria, dysphagia, sialorrhoea, micrographia, shuffling gait, and non-motor symptoms such as autonomic dysfunction, and cognitive and neurobehavioral abnormalities. It affects 2-3% of the population older than 65 years of age, with an overall global prevalence of 0.3%, increasing with age. There are five to 35 new cases of Parkinson's disease annually per 100,000 population [4]
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