[Shifting to subcutaneous infusion of apomorphine in advanced Parkinson's disease patients on an out-patient basis: experience and recommendations].
BACKGROUND
Shifting from oral medication to continuous subcutaneous infusion of apomorphine (CSIA) in Parkinson's disease (PD) may be complicated. It is unclear whether hospitalization is necessary.


OBJECTIVE
To observe efficacy and side effects in advanced PD patients shifting to CSIA managed as out-patients with hospital-based support.


METHODS
CSIA was started on 7 PD patients with uncontrollable on-off fluctuations on a waiting list for surgery. Two patients were initially admitted to hospital, all others being managed as out-patients. Awake off time was assessed with daily charts and motor function with UPDRS subscale and a scale for dyskinesias severity. Appropriate scales were applied for mood changes, neuropsychiatric complications and quality of life measures. Apomorphine dosage and oral antiparkinsonian medication were adjusted daily (mean: 6.1 days) according to motor responses. Follow-up visits were scheduled at 3 and 6 months. Patients were offered phone calls, unprogrammed visits, and 24 hours neurological care if required.


RESULTS
All patients required phone calls (mean, 4.4), but unprogrammed visits were rare (1.5). Off-time was reduced in the overall group by a 68.1 %. Co-medication with levodopa was necessary in all patients, but all other antiparkinsonian medications could be discontinued.


CONCLUSIONS
Shifting from oral dopaminergic therapy to CSIA is safe and effective in advanced PD managed on an out-patient basis in a hospital-based setting providing that daily in-person evaluation is available during the first week and follow-up by phone calls thereafter.
Castaño
B
B
Servicio de Neurología, Hospital General Universitario Gregorio Marañón, Madrid. bechi2001@hotmail.com
Mateo
D
D
Giménez-Roldán
S
S
D000368:Aged; D000553:Ambulatory Care / Q000706:statistics & numerical data; D000978:Antiparkinson Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D001058:Apomorphine / Q000008:administration & dosage* / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006099:Granuloma / Q000209:etiology; D006801:Humans; D007263:Infusions, Parenteral / Q000009:adverse effects; D007980:Levodopa / Q000008:administration & dosage / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D010044:Outpatient Clinics, Hospital; D010300:Parkinson Disease / Q000188:drug therapy*; D011446:Prospective Studies; D040521:Subcutaneous Tissue / Q000473:pathology; D013689:Telephone
D000978:Antiparkinson Agents; D007980:Levodopa; D001058:Apomorphine