Ελληνικα

Abstract

Background: Apomorphine is a potent short-acting dopamine receptor agonist for the treatment of Parkinson disease. In Greece, official guidelines for its use in everyday clinical practice are lacking.

Aim: This document is designed to serve as an evidence-based expert consensus on how to identify and treat PD patients that could benefit from apomorphine intermittent injection or continuous apomorphine infusion.

Results: In Greece, apomorphine can be found in two formulations; as a pen for subcutaneous injection and as a pump for continuous infusion. Due to its rapid onset of action, apomorphine injection can be used as a rescue therapy in case off symptoms emerge despite good compliance to medications, such as in morning akinesia, unpredictable off periods, delayed “on” or dose failures due to erratic levodopa absorption. As its efficacy does not decrease with time, it can be used from the early years of the  advanced disease stage. Apomorphine continuous infusion is one the three device-aided treatments that are recommended for the treatment of motor fluctuations that can no longer be controlled with oral medications. It results in a significant reduction in daily off-time. Apomorphine infusion is easily implemented, does not require the cooperation of other medical specialties and is less invasive compared to intrajejunal levodopa infusion and deep-brain stimulation. However, it is the patient’s profile that will dictate the best device-aided treatment choice for the management of each advanced PD patient.

Concusion: Apomorphine holds a unique place in the armentarium of advanced Parkinson disease treatment. Neurologists need to get familiar with its use and offer it to their patients.