Prospects of successful treatment of Parkinson's disease using apomorphine

Optimising the treatment of idiopathic Parkinson's disease is a complex, multifaceted and continuous process that directly affects quality of life. The main position of this examination is the need for individualised therapy that provides optimal motor function with the least negative consequences. Apomorphine, a dopamine agonist used as rescue therapy for patients with motor fluctuations with a potentially positive effect on non-motor symptoms, is the only antiparkinsonian drug whose ability to control motor symptoms is equivalent to that of levodopa. Subcutaneous injection is the most effective and affordable way to correct dopaminergic insufficiency in Parkinson's disease. The data of multi-centre studies presented in the review confirm the high efficiency, adequate tolerability, and prospects of using apomorphine in the complex pathogenetic therapy of the disease. This review provides historical background and summarises the structure, mechanism of action, pharmacodynamics, indications, contraindications, and side effects of subcutaneous apomorphine injections in the advanced stages of Parkinson's disease. Keywords: Parkinson's disease; apomorphine; pharmacokinetics; mechanism of action; clinical trials; indications: and contraindications

Continuous Subcutaneous Apomorphine Infusion in Parkinson’s Disease: A Single-Center, Long-Term Follow-Up Study of the Causes for Discontinuation

(1) Background: Subcutaneous apomorphine infusion (SCAI) is one of the three main treatment options for motor fluctuations in advanced Parkinson’s disease (PD). The adherence to SCAI is generally considered to be low due to adverse events and because it is perceived as a treatment option to be used for a limited period only. We evaluated the reasons for discontinuation of SCAI in relation to when patients stopped treatment. (2) Methods: We reviewed the medical records of PD patients treated with SCAI at a single center, capturing patient demographics and the reasons for cessation of SCAI. (3) Results: 101 patients were included in the analysis, with a median time on treatment of 6.34 years. The main reasons for stopping SCAI were adverse events, death, and dissatisfaction with treatment. In the first 6 years of treatment, the predominant side effects leading to discontinuation were somnolence and hallucinations. (4) Conclusions: We suggest that SCAI can be an effective long-term treatment option for advanced PD, but it requires careful patient selection, a high level of communication with the patient and carer, and rigorous monitoring of the effects of treatment and for any adverse events so they can be promptly managed.

Continuous subcutaneous apomorphine infusion allowing awake deep brain stimulation in a Parkinson’s disease patient

Background Subthalamic Deep Brain Stimulation (DBS) have demonstrated in the last decades to determine an important clinical improvement in advanced and selected Parkinson’s disease (PD) patients. However, only a minority of parkinsonian patients meet the criteria to undergo DBS, and the surgical procedure itself is often stressful, especially for patients experiencing severe OFF state. Subcutaneous Apomorphine continuous administration is suitable as an adjunctive therapy capable of improving a suboptimal DBS result. Here we hypothesize a possible role for subcutaneous apomorphine infusion to alleviate severe OFF state in parkinsonian patients undergoing DBS, thus allowing intraoperative microrecording and patient’s collaboration during clinical testing. Case presentation A 68-year-old man, suffering from a very long PD-history, characterized by a severe akinetic status and dramatic non-motor features while in OFF, underwent Subthalamic-DBS keeping a slight but continuous apomorphine infusion (1.8 mg/hour), able to guarantee the right degree of patient’s collaboration without interfering with microelectrode recordings. There were no intra or perioperative complications and after the procedure he experienced a marked clinical benefit, being able to stop apomorphine administration. Conclusions Here we described the first Subthalamic DBS procedure performed with a low and stable dopaminergic stimulation guaranteed by subcutaneous Apomorphine continuous infusion. For its rapidity of action and prompt reversibility, apomorphine could be particularly suitable for use during difficult surgical procedures in PD, allowing more therapeutic opportunities for patients who would otherwise be excluded from the DBS option.