Continuous Apomorphine Infusion in Patients with Advanced Parkinson’s Disease with Varying Degrees of Functional Impairment

Abstract

Introduction: Continuous apomorphine infusion (CAI) is effective in improving complications in advanced Parkinson's disease (APD). The effectiveness and tolerance of CAI in patients with APD with varying degrees of functional impairment was studied. Methods: In this comparative observational study, consecutive APD who started treatment with CAI were included. They were classified into two groups of functional impairment: A) moderate (Schwab and England (S & E) = 60%-80% and Hoehn and Yahr (H & Y) = 2-3; Group (A), and (B) severe (S & E < 60; H & Y > 3; Group B). Clinical follow-up was performed with concomitant medication and CAI adjustment at 3, 6 and 12 months. Clinical evaluation included a dyskinesia diary and AIMS, S & E, NPI, NMSS and HADS questionnaires. Results: Eighteen patients participated (A = 9 and B = 9) with EP diagnosed 7 (A) and 13 (B) years before. Their baseline dose of levodopa was 728 mg (A) and 925 mg (B), which did not change during follow-up. Dopamine agonists were progressively reduced in both groups. Progressive titration of CAI resulted in abandonment of apomorphine bolus administration. Both groups experienced improvements in all variables, higher in group A; motor fluctuations = 69% (A), 53% (B); AIMS = 82% (A), 71 (B); S & E = 32% (A), 18% (B); NMS = 62% (A), 19% (B); NPI = 75% (A), 50% (B); HADS (anxiety) = 26% (A), 21% (B); HADS (depression) = 52% (A), 31% (B). Adverse effects were generally mild and resolved without reducing CAI dose. There were no withdrawals. Conclusions: Patients with APD and moderate functional impairment treated with CAI may obtain greater functional, cognitive and emotional improvement than patients more severely affected.