XXVIII Congress LIMPE (Alba, 7-8 November 2001)

Italian Association of Parkinson’s Disease, Extrapyramidal Syndromes and Dementia

EXTRAPYRAMIDAL DISEASES AND DEMENTIA TESTING AND CLINICAL CORRELATION

PARKINSONIAN THERAPY WITH APOMORPHINE SUBCUTANEOUS INFUSION

Nordera GP, Stocchi F, Barbato L, Grassini P, De Pandis MF, Vacca L, Ruggieri S.

Clinical and experimental remarks suggest that continuous dopamine stimulation can prevent or improve movement fluctuations of patients with Parkinson’s disease in an advanced condition. The subcutaneous administration of Apomorphine, through portable time-regulated infusion pumps, has proved effective in controlling the inconveniences of a pulse therapy. Patients’ selection and management is basically important for the success of such a therapy. We report the data of 55 patients (30 men and 15 women) suffering from Parkinson’s Disease treated with continuous subcutaneous infusion of Apomorphine. At the beginning of the therapy the patients showed an average of 3.9 H&Y, age 61.04+/-7.5 years (range 42-71), average disease lasting of 14.8+/-5.47 (range 5-24) in treatment with levodopa from 14.0+/- 4.7 years (range 5-23), in therapy with oral ratings of levodopa with average of 725 mg/per day. Having been established optimal infusion rates based on the therapeutic answer and tolerance, the patients have been treated with Apomorphine subcutaneous infusion costantly delivered in the lapse of 12-15 day hours with 2.5-8 mg/h rates. There have been employed battery computerized micro-pumps, of reduced dimensions and easy to wear (as Microjet Crono Par - Canè), capable of delivering extra Apomorphine bolus. The average Apomorphine dose that appeared necessary to allow optimal control of Parkinson simptomatology was 4,3 mg/h, at the time of the first discharge. Afterward the dosage has demanded on average only slight increases, keeping rather constant in studied population. Joined levodopa needs, at the beginning of infusion period, has on the contrary been reduced from an average of 708.3 mg/per day up to 375 mg/per day. Furtherly it has raised again, but remaining under 2.5 basal value. “Off” hours, calculated over12 hours, have been reduced initially from an average of 4.6 up to 0.9 after 6 months, remaining then constant during the time about 2.5. values. Movement fluctuations too have shown a clear improvement. In fact, dyskinesias haS proved to be reduced initially from 3.6 value (scale AIMS) to 2 value after 6 months and staying substantially with unchanged values. Significant clinical instrumental parametres alterations (haematochemical testing, EGC) have not been reported. Nearly all the patients treated with infusion have developed subcutaneous abdominal nodules in correspondence with the place of needle insertion.