Use of apomorphine in parkinsonian patients with neuropsychiatric complications to oral treatment

Ellis, Claire; Lemmens, Gilbert; Parkes, J. D.; Abbott, R. J.; Pye, I F; Leigh, P. Nigel; Chaudhuri, K. Ray

doi:10.1016/s1353-8020(97)00009-6

Cited by 61 publications

(34 citation statements)

References 6 publications

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“…The beneficial effects of apomorphine in the treatment of neuropsychiatric symptoms (predominantly VH) in patients with PD have been reported in a number of case series [9][10][11]. Altogether these case series describe long-term follow-up (8-72 months) of 16 PD patients, 12 with reported VH.…”

Section: B) Apomorphinementioning

confidence: 94%

“…Altogether these case series describe long-term follow-up (8-72 months) of 16 PD patients, 12 with reported VH. Eleven described a dramatic reduction in visual symptoms with only mild persistence in the remaining case [9].…”

Section: B) Apomorphinementioning

confidence: 98%

“…No worsening of VH has been reported in advanced PD patients receiving apomorphine treatment with long-term follow-up in descriptive studies [63][64][65][66] and apomorphine has even been suggested to have a beneficial effect on VH [9,12]. The antipsychotic potential of apomorphine was first reported in patients diagnosed with schizophrenia [67,68].…”

Section: B) Apomorphinementioning

confidence: 99%

“…This piperidine moiety is also incorporated in the chemical structure of many antipsychotic medications, including piperidine phenothiazines, haloperidol, risperdone, bulbocapnine and other aporphines [75,76]. Based on the structural similarities, it has been argued that the antipsychotic potential of apomorphine is due to the specific action of this piperidine moiety in binding to dopaminergic and serotonergic receptors (particularly 5-HT2A-receptors), producing an antagonistic effect [9,12,[76][77][78].…”

Section: Chemical Structure and Receptor Binding Profile Of Apomorphinementioning

confidence: 99%

“…This suggests that VH are not directly caused by dopaminergic overstimulation, but that treatment may act as a precipitating factor. In contrast, evidence from a number of case series and a single open-label prospective trial suggest that apomorphine (potent dopamine agonist) has the potential to alleviate some of the symptoms of VH [9][10][11][12].…”

Section: Introductionmentioning

confidence: 96%

See 4 more Smart Citations

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

Borgemeester

Lees²,

Laar

2016

Parkinsonism & Related Disorders

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Section: B) Apomorphinementioning

confidence: 94%

Section: B) Apomorphinementioning

confidence: 98%

Section: B) Apomorphinementioning

confidence: 99%

Section: Chemical Structure and Receptor Binding Profile Of Apomorphinementioning

confidence: 99%

Section: Introductionmentioning

confidence: 96%

See 3 more Smart Citations

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

Borgemeester

Lees²,

Laar

2016

Parkinsonism & Related Disorders

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A Retrospective Evaluation of the Frequency of Impulsive Compulsive Behaviors in Parkinson's Disease Patients Treated with Continuous Waking Day Apomorphine Pumps

Barbosa

Lees

Magee

et al. 2016

Movement Disord Clin Pract

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Background Impulsive compulsive behaviors (ICBs) can have a deleterious impact on the lives of patients with PD with orally active dopamine agonist treatment recognized as the greatest risk factor. However, the relationship between subcutaneous administration of the dopamine agonist, apomorphine, and impulsive compulsive behaviors is unknown. Methods We conducted a retrospective analysis of 28 advanced PD patients treated with subcutaneous waking day apomorphine ambulatory minipumps at the National Hospital for Neurology and Neurosurgery (London, UK). Results Twelve of the patients had experienced impulsive compulsive behaviors before starting apomorphine. Reduction of oral dopamine agonist dose before apomorphine had led to complete resolution in 6 cases with no recurrence on long‐term apomorphine maintenance therapy. Six patients still had active impulsive compulsive behaviors when apomorphine was started. Four of these improved, and in the other 2 there was no worsening. Of the 16 patients with no previous history of impulsive compulsive behaviors who started apomorphine, only 1, who was still receiving concurrent levodopa, developed impulsive compulsive behaviors. Conclusions These data provide preliminary evidence that continuous apomorphine pump therapy has a lower proclivity to trigger or exacerbate impulsive compulsive behaviors than oral dopamine agonists. This is likely to be attributed to a more tonic stimulation of striatal dopamine receptors leading to desensitisation, but could also be attributed to a different pharmacological profile of apomorphine compared with orally active dopamine agonists. Apomorphine can be considered as a treatment option in patients who have developed disabling impulsive compulsive behaviors on oral agonist therapy whose motor handicap cannot be controlled adequately on l‐dopa alone. Further prospective studies are needed to provide a definitive answer to this question.

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Apomorphine monotherapy in the treatment of refractory motor complications of Parkinson's disease: Long‐term follow‐up study of 64 patients

2002

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Continuous subcutaneous infusion of apomorphine is now increasingly recognized as an effective treatment for refractory off periods and peak-dose dyskinesias in Parkinson's disease. We have reviewed our experience with apomorphine infusions, after a strategy decision in 1995 based on emerging preclinical data, to treat all patients with steady-state plasma levels of apomorphine throughout the waking day, minimizing additional pulsatile stimulation either by oral dopaminergic medication or bolus parenteral injections of apomorphine. Sixty-four patients have been treated with apomorphine pumps and 45 of these successfully converted to monotherapy, managing to discontinue all other forms of dopaminergic stimulation during the daytime treatment period with apomorphine. Patients were followed up for a mean of 33.8 months (range, 4-108 months) and clinical data analyzed retrospectively. The mean maintenance dose of apomorphine was 98 mg per 24 hours (monotherapy group: 103 mg/24 hours; polytherapy group: 93 mg/24 hours), which did not significantly increase at final follow-up. There was a mean maximum dyskinesia reduction of 64% (S.D. = 20) in the monotherapy group, compared to 30% (S.D. = 33) in those continuing on polytherapy (P < 0.001), despite a maintained increase in on time (monotherapy group: 55%, P < 0.005; polytherapy group: 50%, P = 0.05). Fifteen patients failed to successfully convert to monotherapy but benefited nonetheless, and only 3 failed apomorphine infusional therapy altogether. Reasons for failure were mixed, including difficulty with compliance and adverse effects such as daytime somnolence, skin complications, and painful dystonias. There was a significantly higher success rate in patients able to manage the treatment either independently or with the help of their caregiver. These results confirm that subcutaneous apomorphine monotherapy can reset peak-dose dyskinesia threshold in levodopa-treated patients and further reduce off-period disability after all available forms of oral medication, including long-acting dopamine agonists, have been tried.

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Use of apomorphine in parkinsonian patients with neuropsychiatric complications to oral treatment

Cited by 61 publications

References 6 publications

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

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

A Retrospective Evaluation of the Frequency of Impulsive Compulsive Behaviors in Parkinson's Disease Patients Treated with Continuous Waking Day Apomorphine Pumps

Apomorphine monotherapy in the treatment of refractory motor complications of Parkinson's disease: Long‐term follow‐up study of 64 patients

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