Subcutaneous apomorphine in Parkinson's disease: response to chronic administration for up to five years.
Subcutaneous apomorphine, administered by continuous waking-day infusion with boluses, or by repeated intermittent injection, was given to 71 parkinsonian patients with severe refractory levodopa related on-off fluctuations for 1-5 years. A mean reduction in daily off period time of approximately 50% was maintained, and the incidence of neuropsychiatric toxicity remained low on long-term follow-up. No clinically significant tolerance or loss of therapeutic effect was seen, although increasingly severe on-phase dyskinesias and postural instability marred the long-term therapeutic response in many patients. Despite these drawbacks, apomorphine, when combined with the peripheral dopamine receptor agonist domperidone, represents a significant therapeutic advance in the management of late-stage Parkinson's disease and should certainly be considered before experimental implantation procedures.
Hughes
A J
AJ
Department of Neurology, Middlesex Hospital, London, England.
Bishop
S
S
Kleedorfer
B
B
Turjanski
N
N
Fernandez
W
W
Lees
A J
AJ
Stern
G M
GM
D000328:Adult; D000368:Aged; D001058:Apomorphine / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007260:Infusion Pumps; D007279:Injections, Subcutaneous; D007980:Levodopa / Q000008:administration & dosage / Q000009:adverse effects; D008134:Long-Term Care; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination / Q000187:drug effects; D010300:Parkinson Disease / Q000188:drug therapy*
D007980:Levodopa; D001058:Apomorphine