Comparison of apomorphine and levodopa infusions in four patients with Parkinson's disease with symptom fluctuations.
BACKGROUND
Motor fluctuations in patients with advanced Parkinson's disease may be successfully treated with subcutaneous apomorphine infusion or intraduodenal levodopa/carbidopa infusion. No comparative trials of these two alternatives were performed.


OBJECTIVE
We present a subanalysis from a randomized crossover clinical trial where levodopa infusion as monotherapy was compared with any other combination of pharmacotherapy in fluctuating patients. Four patients used apomorphine infusion and oral levodopa in the comparator arm. The results of these four patients are presented in detail.


METHODS
The duration of the trial was 3 + 3 weeks. Patients were video-recorded half-hourly on two non-consecutive days of both treatment arms. Blinded video ratings were used. Patient self-assessments of motor function and quality-of-life (QoL) parameters were captured using an electronic diary.


RESULTS
Ratings in moderate to severe "off" state ranged 0-44% on apomorphine infusion and 0-6% on levodopa infusion. Moderate to severe dyskinesias were not recorded in any of the treatments. QoL was reported to be improved in all patients on duodenal levodopa infusion.


CONCLUSIONS
Monotherapy with duodenal infusion of levodopa was more efficacious and brought greater QoL than combination therapy with apomorphine infusion in these fluctuating patients.
Nyholm
D
D
Department of Neuroscience, Neurology, Uppsala University Hospital, Uppsala, Sweden. dag.nyholm@neurologi.uu.se
Constantinescu
R
R
Holmberg
B
B
Dizdar
N
N
Askmark
H
H
D000284:Administration, Oral; D000368:Aged; D001058:Apomorphine / Q000008:administration & dosage* / Q000009:adverse effects; D018592:Cross-Over Studies; D015259:Dopamine Agents / Q000008:administration & dosage / Q000009:adverse effects; D018491:Dopamine Agonists / Q000008:administration & dosage / Q000009:adverse effects; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007260:Infusion Pumps; D055104:Infusions, Subcutaneous; D007980:Levodopa / Q000008:administration & dosage* / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000188:drug therapy* / Q000503:physiopathology*; D011788:Quality of Life; D016896:Treatment Outcome
D015259:Dopamine Agents; D018491:Dopamine Agonists; D007980:Levodopa; D001058:Apomorphine