title: Apomorphine infusion and the long-duration response to levodopa in advanced Parkinson's disease.
abstract: The authors investigated the long-duration response to levodopa in advanced Parkinson's disease. Eight patients with advanced Parkinson's disease disabled by severe ON/OFF fluctuations treated by chronic daytime subcutaneous apomorphine infusion with supplemental oral levodopa were studied. On day 1, oral levodopa was withdrawn at 4:00 pm and on the following morning subcutaneous apomorphine infusion was continued at the same rate without levodopa therapy. While receiving apomorphine alone, seven of the eight patients turned ON, and their usual dyskinesias returned. The ON phase persisted for 60 to 100 minutes (mean, 185.7 minutes) but then, despite continued, constant-rate apomorphine infusion to stabilize plasma levels, switched to an OFF phase. The authors conclude that the clinical effect of apomorphine is sustained by levodopa long-duration response. This effect is probably the result of postsynaptic mechanisms. In patients with advanced Parkinson's disease, the long-duration response to levodopa is present although slightly diminished.
authors.affiliation: Institute of Neurology IRCCS "NEUROMED," Pozzilli, Rome, Italy. fabrizio.stocchi@tin.it
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Stocchi
authors.forename: Alfredo
authors.initials: A
authors.lastname: Berardelli
authors.forename: Laura
authors.initials: L
authors.lastname: Vacca
authors.forename: Luca
authors.initials: L
authors.lastname: Barbato
authors.forename: Alessandra
authors.initials: A
authors.lastname: Monge
authors.forename: Giampietro
authors.initials: G
authors.lastname: Nordera
authors.forename: Stefano
authors.initials: S
authors.lastname: Ruggieri
mesh_terms: D000284:Administration, Oral; D000978:Antiparkinson Agents / Q000008:administration & dosage*; D001058:Apomorphine / Q000008:administration & dosage*; D015259:Dopamine Agents / Q000008:administration & dosage*; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007279:Injections, Subcutaneous; D007980:Levodopa / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000188:drug therapy*; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000978:Antiparkinson Agents; D015259:Dopamine Agents; D007980:Levodopa; D001058:Apomorphine