Subcutaneous continuous apomorphine infusion in fluctuating patients with Parkinson's disease: long-term results

Abstract

Fluctuations in motor disability and dyskinesias are the major problem in the long-term treatment of Parkinson's disease (PD). Many authors and ourselves have shown that by giving patients a continuous infusion of levodopa it is possible to control motor fluctuations. Levodopa can be administered continuously only by intravenous, intragastric or intrajejunal delivery. Continuous dopaminergic stimulation can be achieved more easily by infusing dopamine agonists subcutaneously. Apomorphine is a potent water-soluble dopamine receptor agonist that has been shown to successfully control motor fluctuation when subcutaneously infused in complicated parkinsonian patients. We report the clinical data of 30 PD patients having at least five years of treatment with subcutaneous continuous apomorphine infusion.

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

“…There is general agreement that off-time declines during apomorphine infusion. However, the benefit on dyskinesia is controversial [17,20,21]. In our study, the range of daily apomorphine dose was similar to other published studies.…”

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

“…There have been a few reports of longer-term use outside the trial setting, and such reports have only a few patients [11,17,19]. We therefore reviewed apomorphine usage in patients with Parkinson's disease at The Walton Centre over the last 10 years, to assess indications, pattern of use, efficacy, and side effect profile.…”

Cabergoline Stimulates Synthesis and Secretion of Nerve Growth Factor, Brain-Derived Neurotrophic Factor and Glial Cell Line-Derived Neurotrophic Factor by Mouse Astrocytes in Primary Culture

“…However, chronic levodopa therapy is associated with long-term motor fluctuations and dyskinesia [1]. Studies have shown that dyskinesias appear when animals are treated with short half-life -but not long-acting dopamine agonists [2]. We have shown in a previous report that cabergoline has longer-acting antiparkinsonian effects than both pergolide and bromocriptine in 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP)-lesioned parkinsonian monkeys [3].…”