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a Section of Restorative Neurology, Department of
Clinical Neuroscience, Division of Neurology, University Hospital,
S-221 85 Lund, Sweden, b Department of Neurology, Medical School Hannover, D-30623
Hannover, Germany
Correspondence to: Dr Katja Pietz, Department of Neurology, Medical School, Hannover, D-30623 Hannover, Germany. Telephone 0049 511 532 3580; fax 0049 511 532 3115.
Received 25 February 1997 and in revised form 6 May 1998;
Accepted 15 June 1998
OBJECTIVES
Despite the recent introduction of new
peroral drugs as well as neurosurgical methods for Parkinson's
disease, treatment of late stage parkinsonian patients remains
difficult and many patients become severely handicapped because of
fluctuations in their motor status. Injections and infusions of
apomorphine has been suggested as an alternative in the treatment of
these patients, but the number of studies describing the effects of
such a treatment over longer time periods is still limited. The
objective was to investigate the therapeutic response and range of side
effects during long term treatment with apomorphine in advanced
Parkinson's disease.
METHODSForty nine patients (30 men, 19 women; age
range 42-80 years) with Parkinson's disease were treated for 3 to 66 months with intermittent subcutaneous injections or continuous
infusions of apomorphine.
RESULTSMost of the patients experienced a long
term symptomatic improvement. The time spent in "off" was
significantly reduced from 50 to 29.5% with injections and from 50 to
25% with infusions of apomorphine. The quality of the remaining
"off" periods was improved with infusion treatment, but was
relatively unaffected by apomorphine injections. The overall frequency
and intensity of dyskinesias did not change. The therapeutic effects of
apomorphine were stable over time. The most common side effect was
local inflammation at the subcutaneous infusion site,
whereas the most severe were psychiatric side effects occurring in 44%
of the infusion and 12% of the injection treated patients.
CONCLUSIONSubcutaneous apomorphine is a highly
effective treatment which can substantially improve the symptomatology
in patients with advanced stage Parkinson's disease over a prolonged
period of time.
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