Skip to main content
Postgraduate Medical Journal logoLink to Postgraduate Medical Journal
. 1994 May;70(823):344–346. doi: 10.1136/pgmj.70.823.344

Subcutaneous apomorphine infusion in Parkinson's disease: does it have a role?

K A Muhiddin 1, M T Roche 1, V R Pearce 1
PMCID: PMC2397604  PMID: 8016004

Abstract

Apomorphine is a potent dopamine agonist at both D1 and D2 receptors and has been used successfully for treating the 'on/off' phenomenon in Parkinson's disease. We report our experience with apomorphine in treating the 'on/off' phenomenon in L-dopa responsive idiopathic Parkinson's disease. Thirteen such patients were commenced on apomorphine infusions. Their mean age was 69 (range 53-80) years and the mean duration of the disease was 15 (range 6-28) years. The clinical response to apomorphine was good in four patients, fair in two, unchanged in five and worse in two. Activities of daily living improved in six, were unchanged in five and worse in two. When the response was poor or showed no change, apomorphine was discontinued. In addition, apomorphine was also discontinued in three patients who had had a fair/good response but suffered side effects of hallucinations, delusions and psychosis, lack of cooperation or found the pump inconvenient. Apomorphine was continued in only three patients out of 13.

Full text

PDF
344

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Bernheimer H., Birkmayer W., Hornykiewicz O., Jellinger K., Seitelberger F. Brain dopamine and the syndromes of Parkinson and Huntington. Clinical, morphological and neurochemical correlations. J Neurol Sci. 1973 Dec;20(4):415–455. doi: 10.1016/0022-510x(73)90175-5. [DOI] [PubMed] [Google Scholar]
  2. Calne D. B., Plotkin C., Williams A. C., Nutt J. G., Neophytides A., Teychenne P. F. Long-term treatment of parkinsonism with bromocriptine. Lancet. 1978 Apr 8;1(8067):735–738. doi: 10.1016/s0140-6736(78)90856-5. [DOI] [PubMed] [Google Scholar]
  3. Chaudhuri K. R., Critchley P., Abbott R. J., Pye I. F., Millac P. A. Subcutaneous apomorphine for on-off oscillations in Parkinson's disease. Lancet. 1988 Nov 26;2(8622):1260–1260. doi: 10.1016/s0140-6736(88)90860-4. [DOI] [PubMed] [Google Scholar]
  4. Cotzias G. C., Papavasiliou P. S., Gellene R. Modification of Parkinsonism--chronic treatment with L-dopa. N Engl J Med. 1969 Feb 13;280(7):337–345. doi: 10.1056/NEJM196902132800701. [DOI] [PubMed] [Google Scholar]
  5. Davidson L., Lloyd K., Dankova J., Hornykiewicz O. L-DOPA treatment in Parkinson's disease: effect on dopamine and related substances in discrete brain regions. Experientia. 1971 Sep 15;27(9):1048–1049. doi: 10.1007/BF02138873. [DOI] [PubMed] [Google Scholar]
  6. Frankel J. P., Lees A. J., Kempster P. A., Stern G. M. Subcutaneous apomorphine in the treatment of Parkinson's disease. J Neurol Neurosurg Psychiatry. 1990 Feb;53(2):96–101. doi: 10.1136/jnnp.53.2.96. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Hardie R. J., Lees A. J., Stern G. M. On-off fluctuations in Parkinson's disease. A clinical and neuropharmacological study. Brain. 1984 Jun;107(Pt 2):487–506. doi: 10.1093/brain/107.2.487. [DOI] [PubMed] [Google Scholar]
  8. Marsden C. D., Parkes J. D. "On-off" effects in patients with Parkinson's disease on chronic levodopa therapy. Lancet. 1976 Feb 7;1(7954):292–296. doi: 10.1016/s0140-6736(76)91416-1. [DOI] [PubMed] [Google Scholar]
  9. Nutt J. G., Woodward W. R., Hammerstad J. P., Carter J. H., Anderson J. L. The "on-off" phenomenon in Parkinson's disease. Relation to levodopa absorption and transport. N Engl J Med. 1984 Feb 23;310(8):483–488. doi: 10.1056/NEJM198402233100802. [DOI] [PubMed] [Google Scholar]
  10. Obeso J. A., Grandas F., Vaamonde J., Rosario Luguin M., Martínez-Lage J. M. Apomorphine infusion for motor fluctuations in Parkinson's disease. Lancet. 1987 Jun 13;1(8546):1376–1377. doi: 10.1016/s0140-6736(87)90679-9. [DOI] [PubMed] [Google Scholar]
  11. Obeso J. A., Luquin M. R., Martínez-Lage J. M. Lisuride infusion pump: a device for the treatment of motor fluctuations in Parkinson's disease. Lancet. 1986 Mar 1;1(8479):467–470. doi: 10.1016/s0140-6736(86)92929-6. [DOI] [PubMed] [Google Scholar]
  12. Poewe W., Kleedorfer B., Gerstenbrand F., Oertel W. Subcutaneous apomorphine in Parkinson's disease. Lancet. 1988 Apr 23;1(8591):943–943. doi: 10.1016/s0140-6736(88)91755-2. [DOI] [PubMed] [Google Scholar]
  13. Ruggieri S., Stocchi F., Carta A., Agnoli A. Side-effects of subcutaneous apomorphine in Parkinson's disease. Lancet. 1989 Mar 11;1(8637):566–566. doi: 10.1016/s0140-6736(89)90116-5. [DOI] [PubMed] [Google Scholar]
  14. SCHWAB R. S., AMADOR L. V., LETTVIN J. Y. Apomorphine in Parkinson's disease. Trans Am Neurol Assoc. 1951;56:251–253. [PubMed] [Google Scholar]
  15. Shaw K. M., Lees A. J., Stern G. M. The impact of treatment with levodopa on Parkinson's disease. Q J Med. 1980;49(195):283–293. [PubMed] [Google Scholar]
  16. Stibe C. M., Lees A. J., Kempster P. A., Stern G. M. Subcutaneous apomorphine in parkinsonian on-off oscillations. Lancet. 1988 Feb 20;1(8582):403–406. doi: 10.1016/s0140-6736(88)91193-2. [DOI] [PubMed] [Google Scholar]
  17. Tolosa E. S., Martin W. E., Cohen H. P., Jacobson R. L. Patterns of clinical response and plasma dopa levels in Parkinson's disease. Neurology. 1975 Feb;25(2):177–183. doi: 10.1212/wnl.25.2.177. [DOI] [PubMed] [Google Scholar]
  18. Walters J. R., Bergstrom D. A., Carlson J. H., Chase T. N., Braun A. R. D1 dopamine receptor activation required for postsynaptic expression of D2 agonist effects. Science. 1987 May 8;236(4802):719–722. doi: 10.1126/science.2953072. [DOI] [PubMed] [Google Scholar]

Articles from Postgraduate Medical Journal are provided here courtesy of BMJ Publishing Group

RESOURCES