Subcutaneous apomorphine in late stage Parkinson's disease: along term follow up

OBJECTIVES—Despite the recent introduction of newperoral drugs as well as neurosurgical methods for Parkinson'sdisease, treatment of late stage parkinsonian patients remainsdifficult and many patients become severely handicapped because offluctuations in their motor status. Injections and infusions ofapomorphine has been suggested as an alternative in the treatment ofthese patients, but the number of studies describing the effects ofsuch a treatment over longer time periods is still limited. Theobjective was to investigate the therapeutic response and range of sideeffects during long term treatment with apomorphine in advancedParkinson's disease.
METHODS—Forty nine patients (30 men, 19 women; agerange 42-80 years) with Parkinson's disease were treated for 3 to 66 months with intermittent subcutaneous injections or continuousinfusions of apomorphine.
RESULTS—Most of the patients experienced a longterm symptomatic improvement. The time spent in "off" wassignificantly reduced from 50 to 29.5% with injections and from 50 to25% with infusions of apomorphine. The quality of the remaining"off" periods was improved with infusion treatment, but wasrelatively unaffected by apomorphine injections. The overall frequencyand intensity of dyskinesias did not change. The therapeutic effects ofapomorphine were stable over time. The most common side effect waslocal inflammation at the subcutaneous infusion site,whereas the most severe were psychiatric side effects occurring in 44%of the infusion and 12% of the injection treated patients.
CONCLUSION—Subcutaneous apomorphine is a highlyeffective treatment which can substantially improve the symptomatologyin patients with advanced stage Parkinson's disease over a prolongedperiod of time.