Continuous subcutaneous waking day apomorphine in the long term treatment of levodopa induced interdose dyskinesias in Parkinson's disease

OBJECTIVES—To determine whether continous wakingday dopaminergic stimulation with the dopamine agonist apomorphine canreduce levodopa induced dyskinesias in Parkinson's disease
METHODS—19 patients with severe unpredictablerefractory motor fluctuations and functionally disabling levodopainduced dyskinesias were treated with continuous subcutaneoiusapomorphine monotherapy for a minimum duration of 2.7 years
RESULTS—A mean 65% reduction in dyskineticseverity and a mean 85% reduction in frequency and duration occurred.On discontinuing levodopa a concomitant reduction in off period timewas also seen (35% of waking day "off" reduced to 10%)
CONCLUSION—Continuous waking day dopaminergicstimulation with apomorphine reset the threshold for dyskinesias andled to a pronounced reduction in their frequency.Apomorphine should be considered as a less invasive alternative topallidotomy or deep cerebral stimulation in controlling levodopainduced interdose dose dyskinesias.