INTRANASAL APOMORPHINE RESCUE THERAPY FOR PARKINSONIAN OFF PERIODS

Eleven patients with levodopa-related motor fluctuations were scored b efore and after intranasal apomorphine monotherapy, and the motor resp onses were compared with those with levodopa/carbidopa in this open-la bel study. Oral trimethobenzamide was used to prevent apomorphine-indu ced nausea. Three measures of motor performance were employed: (a) the Unified Parkinson's Disease Rating Scale (UPDRS) motor battery; (b) a timed hand-tapping test; and (c) the Webster's step-seconds test. The magnitude of the motor-score improvement after apomorphine administra tion was very similar to that after the usual doses of levodopa/carbid opa in the 10 patients completing the study; this was true for all thr ee outcome measures. A major advantage of apomorphine was the rapid on set of clinical response, which typically occurred in <10 min, as well as the ease of administration. Major side effects, beyond those exper ienced with levodopa/carbidopa, were limited to nausea and vomiting (t hree patients) and orthostatic hypotension (one patient); however, onl y a single patient dropped out of the study as a consequence. These re sults indicate that intranasal apomorphine is effective in rapidly rel ieving parkinsonian ''off'' states and that, for most patients, trimet hobenzamide is an effective and well-tolerated antiemetic for use with apomorphine.