Subcutaneous apomorphine for parkinsonian patients with psychiatric side effects on oral treatment.

Section: B) Apomorphinementioning

confidence: 91%

Section: Introductionmentioning

confidence: 97%

Parkinson's disease, visual hallucinations and apomorphine: A review of the available evidence

Borgemeester

Lees²,

Laar

2016

“…mild hallucinations, moderate cognitive impairment) are not absolute contraindications to treatment with apomorphine. While hallucinations may occur or worsen as an adverse effect of apomorphine infusion, the treatment has been found to be well tolerated in some patients experiencing visual hallucinations and paranoid ideations [27,28], and one study reported a reduction in hallucinations in patients receiving apomorphine infusion as they were able to reduce their oral PD medication [28]. A study comparing DBS with apomorphine infusion in 25 patients with advanced PD followed-up for 5 years demonstrated a worsening of Neuropsychiatric Inventory (NPI) scores in the DBS group that was not observed in the apomorphine group [29].…”

Section: Suitable Candidates For Continuous Apomorphine Infusion (Pump)mentioning

confidence: 98%

Expert Consensus Group report on the use of apomorphine in the treatment of Parkinson's disease – Clinical practice recommendations

Trenkwalder

Chaudhuri

Ruiz

et al. 2015

143

105

Extensive published evidence supports the use of subcutaneously-administered apomorphine as an effective therapy for Parkinson's disease (PD) but to date no consensus recommendations have been available to guide healthcare professionals in the optimal application of apomorphine therapy in clinical practice. This document outlines best-practice recommendations for selecting appropriate candidates for apomorphine intermittent injection (the pen-injection formulation) or apomorphine continuous infusion (the pump formulation), for initiating patients onto therapy and for managing their ongoing treatment. Apomorphine is a suitable therapeutic option for PD patients who experience troublesome 'off' periods despite optimized treatment with oral PD medications. Due to its speed of onset, apomorphine injection is particularly suited to those patients requiring rapid, reliable relief of both unpredictable and predictable 'off' periods, those who require reliable and fast relief when anticipating an 'off', those with levodopa absorption or gastric emptying problems resulting in delayed or failed 'on', or for rapid relief of early morning dystonia or akinesia. Apomorphine infusion(1) is suited for patients whose 'off' periods can no longer be adequately controlled by standard oral PD treatment or for those in whom rescue doses of apomorphine injection are effective but either needed too frequently (more than 4-6 times per day), or are associated with increasing dyskinesia. In addition to treating motor fluctuations, there is evidence that apomorphine infusion may be effective for the management of specific non-motor symptoms of PD associated with 'off' periods. Apomorphine infusion is less invasive than other non-oral treatment options for advancing disease, intrajejunal levodopa infusion and deep-brain stimulation.

“…The underling mechanisms responsible for improvement in psychosis might be related to the reduction of potentially aggravating drugs and/or the relatively low proclivity of apomorphine to induce visual hallucinations. Some authors have argued that the possible serotonin antagonistic effect of the piperidine moiety [40,42] and the potential ability of apomorphine to increase lower-order visual perception are possible explanations for these observations [40].…”

Section: Apomorphine and Neuropsychiatric Symptomsmentioning

confidence: 99%

The efficacy of apomorphine – A non-motor perspective

Rosa-Grilo

Qamar

Evans

2016

Non-motor features have a great impact on progression and quality of life in individuals with Parkinson's disease. Current treatments for PD are limited and apomorphine is one of the advanced therapies available with advantageous effects on motor complications. Several studies have suggested that apomorphine has potential benefits in PD patients beyond its established role in the treatment of motor fluctuations and levodopa-induced dyskinesia. This review examines the efficacy of apomorphine in the treatment of non-motor symptoms (NMS), describing recent studies that highlight its possible effect on cognition. Despite a limited number of studies, the available evidence shows that apomorphine has an overall beneficial effect on NMS of PD patients, including neuropsychiatric symptoms, sleep disturbances, pain, urinary dysfunction, and impulse control disorders. If the effects of apomorphine on amyloid deposition are confirmed in the future, its place in the armamentarium of PD treatment could see a shift towards younger and non-demented PD patients.