Intranasal apomorphine rescue therapy for parkinsonian "off" periods.
Eleven patients with levodopa-related motor fluctuations were scored before and after intranasal apomorphine monotherapy, and the motor responses were compared with those with levodopa/carbidopa in this openlabel study. Oral trimethobenzamide was used to prevent apomorphine-induced nausea. Three measures of motor performance were employed: (a) the Unified Parkinson's Disease Rating Scale (UPDRS) motor battery; (b) a timed hand-tapping test; and (c) the Webster's step-seconds test. The magnitude of the motor-score improvement after apomorphine administration was very similar to that after the usual doses of levodopa/carbidopa in the 10 patients completing the study; this was true for all three outcome measures. A major advantage of apomorphine was the rapid onset of clinical response, which typically occurred in < 10 min, as well as the ease of administration. Major side effects, beyond those experienced with levodopa/carbidopa, were limited to nausea and vomiting (three patients) and orthostatic hypotension (one patient); however, only a single patient dropped out of the study as a consequence. These results indicate that intranasal apomorphine is effective in rapidly relieving parkinsonian "off" states and that, for most patients, trimethobenzamide is an effective and well-tolerated antiemetic for use with apomorphine.
Dewey
R B
RB
Department of Neurology, University of Texas Southwestern Medical School, Dallas 75235-8897, USA.
Maraganore
D M
DM
Ahlskog
J E
JE
Matsumoto
J Y
JY
D000281:Administration, Intranasal; D000932:Antiemetics / Q000627:therapeutic use; D000978:Antiparkinson Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001058:Apomorphine / Q000009:adverse effects / Q000627:therapeutic use*; D001549:Benzamides / Q000627:therapeutic use; D002230:Carbidopa / Q000627:therapeutic use; D018491:Dopamine Agonists / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007024:Hypotension, Orthostatic / Q000139:chemically induced; D007980:Levodopa / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009325:Nausea / Q000139:chemically induced; D010300:Parkinson Disease / Q000188:drug therapy*; D014839:Vomiting / Q000139:chemically induced
D000932:Antiemetics; D000978:Antiparkinson Agents; D001549:Benzamides; D018491:Dopamine Agonists; D007980:Levodopa; D002230:Carbidopa; D001058:Apomorphine; C100146:trimethobenzamide