title: A double-blind study of the efficacy of apomorphine and its assessment in 'off'-periods in Parkinson's disease.
abstract: Five patients with idiopathic Parkinson's disease with severe response fluctuations were selected for a randomized double-blind placebo-controlled study, concerning the clinical effects of subcutaneous apomorphine and its assessment in 'off'-periods. The study was designed as five n = 1 studies, in which every patient was his own control. The effect of apomorphine was studied by using the Columbia rating scale and quantitative assessments, using tapping, walking and pinboard. There was a significant positive effect of apomorphine, in a mean optimal dose of 2.7 mg, with a mean latency of onset of 7.3 min and a mean duration of response of 96 min. After pretreatment with domperidone, no significant adverse effects were observed. Tapping showed the highest correlation with rigidity and bradykinesia. Walking showed a high correlation with stability and gait. Pinboard testing did not give additional information. The first conclusion was that apomorphine proved to be a significantly effective dopamine agonist, proven now also by a double blind placebo-controlled study. Secondly it was concluded that assessment of clinical effect in parkinsonian patients can be performed best by combining the Columbia item tremor with tapping and walking scores.
authors.affiliation: Department of Neurology, Leiden University Hospital, The Netherlands.
authors.forename: T
authors.initials: T
authors.lastname: van Laar
authors.forename: E N
authors.initials: EN
authors.lastname: Jansen
authors.forename: A W
authors.initials: AW
authors.lastname: Essink
authors.forename: C
authors.initials: C
authors.lastname: Neef
authors.forename: S
authors.initials: S
authors.lastname: Oosterloo
authors.forename: R A
authors.initials: RA
authors.lastname: Roos
mesh_terms: D000328:Adult; D000368:Aged; D001058:Apomorphine / Q000008:administration & dosage* / Q000009:adverse effects / Q000493:pharmacokinetics; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007279:Injections, Subcutaneous; D007980:Levodopa / Q000008:administration & dosage / Q000009:adverse effects / Q000493:pharmacokinetics; D008297:Male; D008875:Middle Aged; D009048:Motor Skills / Q000187:drug effects; D009460:Neurologic Examination / Q000187:drug effects*; D010300:Parkinson Disease / Q000097:blood / Q000188:drug therapy*
chemical_list: D007980:Levodopa; D001058:Apomorphine