Continuous subcutaneous waking day apomorphine in the long term treatment of levodopa induced interdose dyskinesias in Parkinson's disease

J Neurol Neurosurg Psychiatry. 1998 May;64(5):573-6. doi: 10.1136/jnnp.64.5.573.

Abstract

Objectives: To determine whether continuous waking day dopaminergic stimulation with the dopamine agonist apomorphine can reduce levodopa induced dyskinesias in Parkinson's disease

Methods: 19 patients with severe unpredictable refractory motor fluctuations and functionally disabling levodopa induced dyskinesias were treated with continuous subcutaneous apomorphine monotherapy for a minimum duration of 2.7 years

Results: A mean 65% reduction in dyskinetic severity and a mean 85% reduction in frequency and duration occurred. On discontinuing levodopa a concomitant reduction in off period time was also seen (35% of waking day "off" reduced to 10%)

Conclusion: Continuous waking day dopaminergic stimulation with apomorphine reset the threshold for dyskinesias and led to a pronounced reduction in their frequency. Apomorphine should be considered as a less invasive alternative to pallidotomy or deep cerebral stimulation in controlling levodopa induced interdose dose dyskinesias.

MeSH terms

  • Aged
  • Antiparkinson Agents / administration & dosage
  • Antiparkinson Agents / adverse effects*
  • Apomorphine / administration & dosage*
  • Apomorphine / adverse effects
  • Chronotherapy
  • Dopamine Agonists / administration & dosage*
  • Dopamine Agonists / adverse effects
  • Dose-Response Relationship, Drug
  • Drug Therapy, Combination
  • Dyskinesia, Drug-Induced / drug therapy*
  • Dyskinesia, Drug-Induced / etiology
  • Female
  • Humans
  • Infusion Pumps, Implantable*
  • Injections, Subcutaneous
  • Levodopa / administration & dosage
  • Levodopa / adverse effects*
  • Male
  • Middle Aged
  • Neurologic Examination / drug effects
  • Parkinson Disease / drug therapy*
  • Treatment Outcome

Substances

  • Antiparkinson Agents
  • Dopamine Agonists
  • Levodopa
  • Apomorphine