A DOUBLE-BLIND-STUDY OF THE EFFICACY OF APOMORPHINE AND ITS ASSESSMENT IN OFF-PERIODS IN PARKINSONS-DISEASE

Five patients with idiopathic Parkinson's disease with severe response fluctuations were selected for a randomized double-blind placebo-cont rolled study, concerning the clinical effects of subcutaneous apomorph ine and its assessment in 'off-periods. The study was designed as five n = 1 studies, in which every patient was his own control. The effect of apomorphine was studied by using the Columbia rating scale and qua ntitative assessments, using tapping, walking and pinboard. There was a significant positive effect of apomorphine, in a mean optimal dose o f 2.7 mg, with a mean latency of onset of 7.3 min and a mean duration of response of 96 min. After pretreatment with domperidone, no signifi cant adverse effects were observed. Tapping showed the highest correla tion with rigidity and bradykinesia. Walking showed a high correlation with stability and gait. Pinboard testing did not give additional inf ormation. The first conclusion was that apomorphine proved to be a sig nificantly effective dopamine agonist, proven now also by a double bli nd placebo-controlled study. Secondly it was concluded that assessment of clinical effect in parkinsonian patients can be performed best by combining the Columbia item tremor with tapping and walking scores.