title: The role of subcutaneous infusion of apomorphine in Parkinson's disease.
abstract: Continuous subcutaneous apomorphine infusion therapy (CSAI) has proved to be effective in advanced Parkinson's Disease patients with motor fluctuations not controlled by oral or transdermal medication. In this clinical setting it competes directly with intrajejunal levodopa and deep brain stimulation (DBS), however randomised controlled comparative studies are lacking. The advantages of CSAI is that it is the least invasive of these three therapeutic options, is reversible, practical to use and has shown significant efficacy for the management of both peak-effect dyskinesias and off-period nonmotor-symptoms. Contraindications to the use of CSAI are severe dementia or neuropsychiatric symptoms and severe biphasic dyskinesias, however unlike DBS, advanced age is not a contraindication. This review summarises the evidence regarding efficacy, safety and tolerability of CSAI, provides guidance on the selection of suitable patients and gives practical instructions on how to initiate CSAI and manage possible adverse events.
authors.affiliation: Department of Neurology, Medical University of Graz, Graz, Austria.
authors.forename: Karoline
authors.initials: K
authors.lastname: Wenzel
authors.forename: Carl Nikolaus
authors.initials: CN
authors.lastname: Homann
authors.forename: Giovanni
authors.initials: G
authors.lastname: Fabbrini
authors.forename: Carlo
authors.initials: C
authors.lastname: Colosimo
mesh_terms: D000978:Antiparkinson Agents / Q000008:administration & dosage* / Q000266:history / Q000494:pharmacology; D001058:Apomorphine / Q000008:administration & dosage* / Q000266:history / Q000494:pharmacology; D046690:Deep Brain Stimulation; D049672:History, 19th Century; D049673:History, 20th Century; D006801:Humans; D055104:Infusions, Subcutaneous / Q000379:methods*; D010300:Parkinson Disease / Q000266:history / Q000628:therapy*
chemical_list: D000978:Antiparkinson Agents; D001058:Apomorphine
keywords: Parkinson’s disease; apomorphine; dyskinesias; levodopa-induced fluctuations; subcutaneous infusion