Subcutaneous apomorphine in parkinson's disease: Response to chronic administration for up to five years

Abstract

Subcutaneous apomorphine, administered by continuous waking‐day infusion with boluses, or by repeated intermittent injection, was given to 71 parkinsonian patients with severe refractory levodopa related on‐off flutuations for 1–5 years. A mean reduction in daily off period time of ∼50% was maintained, and the incidence of neuropsychiatric toxicity remained low on long‐term follow‐up. No clinically significant tolerance or loss of therapeutic effect was seen, although increasingly severe on‐phase dyskinesias and postural instability marred the long‐term therapeutic response in many patients. Despite these drawbacks, apomorphine, when combined with the peripheral dopamine receptor agonist domperidone, represents a significant therapeutic advance in the management of late‐stage Parkinson's disease and should certainly be considered before experimental implantation procedures.