TY - JOUR
T1 - Practical use of apomorphine infusion in Parkinson's disease
T2 - lessons from the TOLEDO study and clinical experience
AU - Henriksen, Tove
AU - Katzenschlager, Regina
AU - Bhidayasiri, Roongroj
AU - Staines, Harry
AU - Lockhart, Donna
AU - Lees, Andrew
N1 - © 2023. The Author(s).
PY - 2023/11
Y1 - 2023/11
N2 - Subcutaneous apomorphine infusion is a device-aided therapy for Parkinson's disease that can be considered when motor fluctuations become persistent and are no longer adequately controlled by oral/transdermal medication. Apomorphine infusion is less invasive than enteral levodopa, deep brain stimulation or focused ultrasound, and is often indicated even when neurosurgical approaches are contraindicated. This article aims to provide practical guidance for doctors and nurses initiating and treating patients with apomorphine infusion, and is based on both trial data and clinical experience from movement disorders specialists. A post hoc analysis of data from the TOLEDO randomized clinical trial of apomorphine infusion was conducted along with an analysis of 'real world' experience from 13 movement disorders specialists using a questionnaire that focused on starting patients on apomorphine infusion. Practical guidelines for starting treatment with apomorphine infusion are provided taking into consideration the regional disparities in healthcare. Apomorphine infusion is straightforward to administer but to be successful it requires concordance from the patient and family, and clinical support from an experienced team of doctors and nurses, particularly in the early months of treatment.
AB - Subcutaneous apomorphine infusion is a device-aided therapy for Parkinson's disease that can be considered when motor fluctuations become persistent and are no longer adequately controlled by oral/transdermal medication. Apomorphine infusion is less invasive than enteral levodopa, deep brain stimulation or focused ultrasound, and is often indicated even when neurosurgical approaches are contraindicated. This article aims to provide practical guidance for doctors and nurses initiating and treating patients with apomorphine infusion, and is based on both trial data and clinical experience from movement disorders specialists. A post hoc analysis of data from the TOLEDO randomized clinical trial of apomorphine infusion was conducted along with an analysis of 'real world' experience from 13 movement disorders specialists using a questionnaire that focused on starting patients on apomorphine infusion. Practical guidelines for starting treatment with apomorphine infusion are provided taking into consideration the regional disparities in healthcare. Apomorphine infusion is straightforward to administer but to be successful it requires concordance from the patient and family, and clinical support from an experienced team of doctors and nurses, particularly in the early months of treatment.
KW - Antiparkinson Agents/therapeutic use
KW - Apomorphine/therapeutic use
KW - Humans
KW - Infusions, Parenteral
KW - Levodopa/therapeutic use
KW - Parkinson Disease/drug therapy
UR - http://www.scopus.com/inward/record.url?scp=85169303749&partnerID=8YFLogxK
U2 - 10.1007/s00702-023-02686-7
DO - 10.1007/s00702-023-02686-7
M3 - Journal article
C2 - 37658155
SN - 0300-9564
VL - 130
SP - 1475
EP - 1484
JO - Journal of neural transmission (Vienna, Austria : 1996)
JF - Journal of neural transmission (Vienna, Austria : 1996)
IS - 11
ER -