Selecting deep brain stimulation or infusion therapies in advanced Parkinson's disease: An evidence-based review

Jens Volkmann, Alberto Albanese, Angelo Antonini, K. Ray Chaudhuri, Carl E. Clarke, Rob M.A. De Bie, Günther Deuschl, Karla Eggert, Jean Luc Houeto, Jaime Kulisevsky, Dag Nyholm, Per Odin, Karen Østergaard, Werner Poewe, Pierre Pollak, Jose Martin Rabey, Olivier Rascol, Evzen Ruzicka, Michael Samuel, Hans SpeelmanOlof Sydow, Francesc Valldeoriola, Chris Van Der Linden, Wolfgang Oertel

Research output: Contribution to journalReview articleResearchpeer-review

102 Citations (Scopus)


Motor complications in Parkinson's disease (PD) result from the short half-life and irregular plasma fluctuations of oral levodopa. When strategies of providing more continuous dopaminergic stimulation by adjusting oral medication fail, patients may be candidates for one of three device-aided therapies: deep brain stimulation (DBS), continuous subcutaneous apomorphine infusion, or continuous duodenal/jejunal levodopa/carbidopa pump infusion (DLI). These therapies differ in their invasiveness, side-effect profile, and the need for nursing care. So far, very few comparative studies have evaluated the efficacy of the three device-aided therapies for specific motor problems in advanced PD. As a result, neurologists currently lack guidance as to which therapy could be most appropriate for a particular PD patient. A group of experts knowledgeable in all three therapies reviewed the currently available literature for each treatment and identified variables of clinical relevance for choosing one of the three options such as type of motor problems, age, and cognitive and psychiatric status. For each scenario, pragmatic and (if available) evidence-based recommendations are provided as to which patients could be candidates for either DBS, DLI, or subcutaneous apomorphine. © 2012 The Author(s).
Original languageEnglish
Pages (from-to)2701-2714
JournalJournal of Neurology
Issue number11
Publication statusPublished - 1 Nov 2013


  • Apomorphine
  • Deep brain stimulation
  • Duodenal levodopa infusion
  • Parkinson's disease


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