Apomorphine Therapy: The Hazard of Left Over Needles

Case Summary

A 55‐year‐old patient with Parkinson's disease (PD) was seen for a shoulder abscess. This abscess was related to the presence of a subcutaneous needle that was disconnected from the tubing used for continuous apomorphine therapy. The patient recovered after abscess incision and antibiotherapy. An X‐ray of the shoulders confirmed that several needles remained subcutaneously in both shoulders (Fig. 1). After changing the type of catheter, no similar event occurred.

Figure 1.

Anteroposterior radiographs of shoulders showing two subcutaneous needles (see arrows) on the right side (R) and four on the left side (L).

After several years with levodopa treatment, PD patients develop motor fluctuations and dyskinesia, linked to iterative stimulations of dopaminergic receptors by multiple daily intakes of dopaminergic drugs. Continuous apomorphine administration may be used as an alternative therapy either as a monotherapy or in association with l‐dopa. Apomorphine reduces significantly the OFF state periods, but also dyskinesia, mainly as a monotherapy.1, 2 Our case report highlights that needles may occasionally be dislocated from tubing, especially when removing the injecting system. It seems that the junction between the needle and the tubing is a weak point and uncoupling may occur, especially in patients with dyskinesia. In this situation, we recommend to use a different injecting system, such as a tangential catheter, which may be more resistant because it is flexible and therefore less breakable. Education to use the injecting system should be performed before starting apomorphine therapy, and special attention should be paid to the monitoring of local side effects in patients treated with subcutaneous apomorphine.

Author Roles

(1) Research Project: A. Conception, B. Organization, C. Execution; D. Supervision; (2) Statistical Analysis: A. Design, B. Execution, C. Review and Critique; (3) Manuscript: A. Writing of the First Draft, B. Review and Critique.

B.D.: 1A, 1B, 1C, 1D, 3A

S.A.: 1C, 3B

E.R.: 1A, 1B, 1C, 3A

M.V.: 1C, 3B

Disclosures

Funding Sources and Conflicts of Interest: The authors report no sources of funding and no conflicts of interest.

Financial Disclosures for previous 12 months: E.R. is the recipient of a grant “poste d'accueil” AP‐HP/CNRS; received research support from INSERM (COSSEC), AP‐HP (DRC‐PHRC), Fondation pour la Recherche sur le Cerveau (FRC), the Dystonia Coalition (Pilot project), Ipsen, Merz‐Pharma, Novartis, Teva, Lundbeck, and Orkyn; served on scientific advisory boards for Orkyn, Ipsen, and Merz‐Pharma; received speech honorarium from Novartis, Teva, and Orkyn; and received travel funding from Teva, Novartis, the Dystonia Coalition, the International Parkinson and Movement Disorder Society (MDS), the World Federation of Neurology Association of Parkinsonism and Related Disorders, and International Federation of Clinical Neurophysiology; M.V. received research support from French national funding for clinical research INSERM, and patient's associations the French Dystonia foundation (AMADYS and alliance France Dystonie) and the essential tremor foundation (APTES); served on scientific advisory boards for Merz; and received travel funding from the MDS and Dystonia Medical Research Foundation; B.D. received research support from INSERM (COSSEC) and the patient's association France Parkinson; received travel funding from Novartis, Teva, Lundbeck, and MERZ‐Pharma; received speech honorarium from Novartis and Medtronic; and served on scientific advisory boards for ORKYN.