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Continuous subcutaneous apomorphine infusion in advanced Parkinson’s disease: 10-year experience with 230 patients

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Abstract

Continuous apomorphine infusion (APO) is one of the treatments available for advanced Parkinson disease (PD). Over 10 years, we have treated 230 patients with APO. Mean age was 66.8 and average evolution time at APO onset was 13.0 years. Mean duration of the treatment was 26.3 months. As of June 2016, 93 remained on the medication (active group), while 137 had stopped. This active group had mean age 67.3 at recruitment and mean evolution 14.2 years. The main indication for APO was lack of deep brain stimulation criteria (DBS). Twelve patients were on waiting list for DBS. Average time since APO onset was 40.0 months. In the active group, APO decreased off-state in 4 h and allowed reducing levodopa and dopamine agonists. Dyskinesia and balance did not worsen. Cognitive decline did not change within the first 15 months. Hallucinations were the same within the first 39 months. The presence of subcutaneous nodules was the most frequent adverse event in this group. The main reason for discontinuation was side effects, being psychosis the most common. Within the first year, 82 patients stopped APO. Eighteen of these patients eventually got DBS. APO is a good option for advanced PD, since it permits a significant reduction in off-time and other antiparkinsonian drugs. This effect is sustained over time. We have treated 132 patients for over a year. Dyskinesia seems not to worsen. Combining APO with DBS simultaneously or alternatively provides good results.

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Authors and Affiliations

  1. Department of Neurology, Movement Disorder Clinic, Complejo Hospitalario Universitario de Santiago de Compostela, 15706, Santiago de Compostela, Spain

    Ángel Sesar, Gustavo Fernández-Pajarín, Begoña Ares, María Teresa Rivas & Alfonso Castro

  2. Department of Neurology, Complejo Hospitalario Universitario de La Coruña, La Coruña, Spain

    María Teresa Rivas

Authors
  1. Ángel Sesar
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  2. Gustavo Fernández-Pajarín
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  3. Begoña Ares
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  4. María Teresa Rivas
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  5. Alfonso Castro
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Corresponding author

Correspondence to Ángel Sesar.

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Conflicts of interests

AS has received honoraria from Britannia/Italfarmaco, Teva, Abbvie and UCB; GFP from Italfarmaco and UCB; BA from Italfarmaco and Abbvie; AC from Abbvie and Zambon; MTR has no conflict of interest.

Author contributions

AS design of the study, acquisition of data, analysis and interpretation and drafting of the article. GFP acquisition of data, analysis and interpretation, revision and final approval. BA acquisition of data, revision and final approval. MTR revision and final approval. AC acquisition of data, revision and final approval.

Funding

This study had no funding.

Ethical approval

As this is a retrospective pure clinical study, no ethical approval or informed consent was required.

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Sesar, Á., Fernández-Pajarín, G., Ares, B. et al. Continuous subcutaneous apomorphine infusion in advanced Parkinson’s disease: 10-year experience with 230 patients. J Neurol 264, 946–954 (2017). https://doi.org/10.1007/s00415-017-8477-0

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  • DOI: https://doi.org/10.1007/s00415-017-8477-0

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