SUBCUTANEOUS APOMORPHINE IN LATE-STAGE PARKINSONS-DISEASE - A LONG-TERM FOLLOW-UP

Objectives-Despite the recent introduction of new peroral drugs as wel l as neurosurgical methods for Parkinson's disease, treatment of late stage parkinsonian patients remains difficult and many patients become severely handicapped because of fluctuations in their motor status. I njections and infusions of apomorphine has been suggested as an altern ative in the treatment of these patients, but the number of studies de scribing the effects of such a treatment over longer time periods is s till Limited. The objective was to investigate the therapeutic respons e and range of side effects during long term treatment with apomorphin e in advanced Parkinson's disease. Methods-Forty nine patients (30 men , 19 women; age range 42-80 years) with Parkinson's disease were treat ed for 3 to 66 months with intermittent subcutaneous injections or con tinuous infusions of apomorphine. Results-Most of the patients experie nced a long term symptomatic improvement. The time spent in ''off'' wa s significantly reduced from 50 to 29.5% with injections and from 50 t o 25% with infusions of apomorphine. The quality of the remaining ''of f'' periods was improved with infusion treatment, but was relatively u naffected by apomorphine injections. The overall frequency and intensi ty of dyskinesias did not change. The therapeutic effects of apomorphi ne were stable over time. The most common side effect was local inflam mation at the subcutaneous infusion site, whereas the most severe were psychiatric side effects occurring in 44% of the infusion and 12% of the injection treated patients. Conclusion-Subcutaneous apomorphine is a highly effective treatment which can substantially improve the symp tomatology in patients with advanced stage Parkinson's disease over a prolonged period of time.