A 10 year retrospective audit of long-term apomorphine use in Parkinson?s disease

Tyne, H; Parsons, Jan; Sinnott, Ann; Fox, Susan H.; Fletcher, Nicholas; Steiger, M. J.

doi:10.1007/s00415-004-0547-4

Cited by 103 publications

(60 citation statements)

References 20 publications

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“…Our results confirm that CSAI is an effective treatment option for patients with PD and severe fluctuations that are poorly controlled by oral drug treatment, but also raise the need of randomized blinded studies [4,[15][16][17][18][19]. There is general agreement that off-time declines during apomorphine infusion.…”

Section: Discussionsupporting

confidence: 86%

A 5-year prospective assessment of advanced Parkinson disease patients treated with subcutaneous apomorphine infusion or deep brain stimulation

et al. 2010

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Prospective comparative long-term data on the effect of deep brain stimulation (DBS) of the subthalamic nucleus (STN) and continuous subcutaneous infusion of apomorphine (CSAI) in patients with advanced Parkinson disease (PD) are lacking. We report 5-year follow-up of 25 PD patients treated with either STN-DBS (n = 13) or CSAI (n = 12) who fulfilled CAPSIT-PD criteria. Cohorts were matched for disease duration and severity of motor complications. Baseline clinical and neuropsychological status did not differ among cohorts. Patients were assessed with the UPDRS, MMSE, HAMD-17 and Neuropsychiatric Inventory (NPI).Twelve subjects reached the 5-year follow-up with STN-DBS (one was lost at follow-up) versus two in the CSAI cohort. Drop-outs with CSAI were due to subcutaneous nodules (n = 2), insufficient control of motor fluctuations and dyskinesia (n = 4), death for unrelated reasons (n = 3) and one was lost at follow-up. Average apomorphine dose at last visit was 83.4 ± 19.2 mg/day and average treatment duration was 30 months. At 1-year as well as at last follow-up (intention-to-treat analysis), both therapies decreased daily off-time but only STN-DBS reduced dyskinesia duration and severity. Decrement of medications was greater with STN-DBS. There was a significant worsening of NPI after STN-DBS, primarily because four subjects developed apathy.

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Section: Discussionsupporting

confidence: 86%

A 5-year prospective assessment of advanced Parkinson disease patients treated with subcutaneous apomorphine infusion or deep brain stimulation

et al. 2010

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“…Apomorphine-pen injections are usually only applied for short periods. Long-term use is the exception for only a limited number of patients, although it is feasible and in some cases quite promising (Hughes et al 1993;Tyne et al 2004;Borgemeester et al 2014). The daily dosage usually average between 3 and 30 mg/die with intermittent apomorphine injections.…”

Section: Specificitiesmentioning

confidence: 95%

“…It is rapidly absorbed after subcutaneous injection reaching maximal plasma levels approximately after 20 min. Clinical effects can be seen five to 15 min post injection (Tyne et al 2004). Therefore, the substance is used in apomorphine tests to assess the response to dopaminergic therapy, as intermittent subcutaneous injections (pen application), as well as continuous subcutaneous infusions using pumps.…”

Section: Apomorphine Introductionmentioning

confidence: 96%

Advanced stages of PD: interventional therapies and related patient-centered care

et al. 2015

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During the last decades, symptomatic treatment of motor symptoms of Parkinson's disease (PD) improved continuously and is reflected by long-range independency of the patient during the disease course. However, advanced stages of PD still represent an important challenge to patients, caregivers and treating physicians. In patients with advanced PD, interventional therapy strategies are increasingly applied. These device-related treatment strategies using pump-based continuous dopaminergic stimulation (CDS) or deep brain stimulation (DBS) opened new treatment options especially if motor complications predominate. Well-designed clinical studies on these interventional therapeutic approaches provided class 1 evidence for the efficacy of DBS and CDS in advanced PD and opened new perspectives for their use in earlier disease stages also. Therefore, careful selection of patients amenable to the (semi)invasive therapy options becomes more and more important and requires an interdisciplinary setting that accounts for (i) optimal patient information and awareness, (ii) selection of best individual treatment modality, (iii) training of relatives and caregivers, (iv) management of complications, and (v) follow-up care. Here, we address these topics by summarizing current state-of-the-art in patient selection, providing specificities of treatment options and troubleshooting, and defining steps towards an optimized patient-centered care. Interventional therapies pioneer in the area of individualized treatment approaches for PD, and may be complemented in the future by biomarker-based improved stratification and by closed-loop systems for adaptive therapeutic strategies. In the present review, we summarize the proceedings of an Expert Workshop on Parkinson's disease held on November 22, 2014 in Frankfurt, Germany.

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“…Apomorphine, which has activity at striatal D1/D2 receptors, is the most potent dopamine agonist and can provide antiParkinson's effect comparable to levodopa [41,42]. When injected subcutaneously it is rapidly absorbed, with effect noticeable in 5-15 min.…”

Section: Intravenous Levodopa and Subcutaneous Apomorphine Infusionmentioning

confidence: 99%

Continuous dopaminergic delivery to minimize motor complications in Parkinson’s disease

Wright

Waters²

2013

Expert Review of Neurotherapeutics

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A 10 year retrospective audit of long-term apomorphine use in Parkinson?s disease

Abstract: Subcutaneous apomorphine is easy for patients to use, is well tolerated and has a low incidence of side effects, especially confusion.

Cited by 103 publications

References 20 publications

A 5-year prospective assessment of advanced Parkinson disease patients treated with subcutaneous apomorphine infusion or deep brain stimulation

A 5-year prospective assessment of advanced Parkinson disease patients treated with subcutaneous apomorphine infusion or deep brain stimulation

Advanced stages of PD: interventional therapies and related patient-centered care

Continuous dopaminergic delivery to minimize motor complications in Parkinson’s disease

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