ABSTRACT
Los nódulos subcutáneos y las complicaciones neuropsiquiátricas son los efectos adversos más relevantes durante el tratamiento con apomorfina en infusión. Los nódulos subcutáneos aparecen casi en la totalidad de los pacientes, y es imprescindible la correcta información y entrenamiento del paciente y su cuidador para minimizar su repercusión en el tratamiento. Las complicaciones neuropsiquiátricas, aunque no son más frecuentes que con otras terapias dopaminérgicas, se relacionan con una mayor dificultad de tratamiento y el empeoramiento de la calidad de vida del paciente (AU)
Subcutaneous nodules and neuropsychiatric complications are the most relevant adverse effects during apomorphine infusion treatment. Subcutaneous nodules appear in almost all the patients and accurate information and training of both patient and caregiver is essential to minimise their impact on the treatment. Although neuropsychiatric complications are not more frequent than with other dopaminergic treatments, they are linked with increasing difficulty of treatment and worsening of patients quality of life (AU)
Subject(s)
Humans , Apomorphine/adverse effects , Antiparkinson Agents/adverse effects , Mental Disorders/chemically induced , Parkinson Disease/drug therapy , Dopamine Agonists/adverse effects , Drug Eruptions/etiology , Infusions, Subcutaneous , Physical Therapy Modalities , Antipsychotic Agents/therapeutic use , Cholinesterase Inhibitors/therapeutic use , Apomorphine/therapeutic use , Antiparkinson Agents/administration & dosage , Mental Disorders/prevention & control , Parkinson Disease/psychology , Combined Modality Therapy , Disease Susceptibility , Dopamine Agonists/administration & dosage , Dopamine Agonists/pharmacokinetics , Drug Eruptions/prevention & control , Drug Eruptions/therapy , Hallucinations/chemically induced , Hallucinations/drug therapy , Hallucinations/etiology , Psychomotor Agitation/drug therapy , Psychomotor Agitation/etiology , Psychoses, Substance-Induced/etiology , Psychoses, Substance-Induced/prevention & control , Severity of Illness Index , Sleep-Wake Transition Disorders/chemically induced , Sleep-Wake Transition Disorders/therapyABSTRACT
Subcutaneous nodules and neuropsychiatric complications are the most relevant adverse effects during apomorphine infusion treatment. Subcutaneous nodules appear in almost all the patients and accurate information and training of both patient and caregiver is essential to minimise their impact on the treatment. Although neuropsychiatric complications are not more frequent than with other dopaminergic treatments, they are linked with increasing difficulty of treatment and worsening of patient's quality of life.
Subject(s)
Antiparkinson Agents/adverse effects , Apomorphine/adverse effects , Dopamine Agonists/adverse effects , Drug Eruptions/etiology , Mental Disorders/chemically induced , Parkinson Disease/drug therapy , Adrenal Cortex Hormones/therapeutic use , Antiparkinson Agents/administration & dosage , Antiparkinson Agents/pharmacokinetics , Antiparkinson Agents/therapeutic use , Antipsychotic Agents/therapeutic use , Apomorphine/administration & dosage , Apomorphine/pharmacokinetics , Apomorphine/therapeutic use , Cholinesterase Inhibitors/therapeutic use , Combined Modality Therapy , Disease Susceptibility , Dopamine Agonists/administration & dosage , Dopamine Agonists/pharmacokinetics , Dopamine Agonists/therapeutic use , Drug Eruptions/prevention & control , Drug Eruptions/therapy , Hallucinations/chemically induced , Hallucinations/drug therapy , Hallucinations/etiology , Humans , Infusions, Subcutaneous , Mental Disorders/prevention & control , Parkinson Disease/psychology , Physical Therapy Modalities , Psychomotor Agitation/drug therapy , Psychomotor Agitation/etiology , Psychoses, Substance-Induced/etiology , Psychoses, Substance-Induced/prevention & control , Severity of Illness Index , Sleep Wake Disorders/chemically induced , Sleep Wake Disorders/therapyABSTRACT
Continuous subcutaneous apomorphine infusion (CSAI) is, at present, an alternative option for advanced Parkinson's disease (PD) with motor fluctuations. We studied the evolution of patients with PD and severe motor fluctuations long-term treated with CSAI. We reviewed data from 82 patients with PD (mean age, 67 +/- 11.07; disease duration, 14.39 +/- 5.7 years) and severe motor fluctuations referred to 35 tertiary hospitals in Spain. These patients were long-term treated (for at least 3 months) with CSAI and tolerated the procedure without serious side effects. We compared the baseline data of these 82 patients (before CSAI) with those obtained from the last follow-up visit of each patient. The mean follow-up of CSAI was 19.93 +/- 16.3 months. Mean daily dose of CSAI was 72.00 +/- 21.38 mg run over 14.05 +/- 1.81 hours. We found a statistically significant reduction in off-hours, according to self-scoring diaries (6.64 +/- 3.09 vs. 1.36 +/- 1.42 hours/day, P < 0.0001), total and motor UPDRS scores (P < 0.0001), dyskinesia severity (P < 0.0006), and equivalent dose of antiparkinsonian therapy (1,405 +/- 536.7 vs. 800.1 +/- 472.9 mg of levodopa equivalent units P < 0.0001). CSAI is an effective option for patients with PD and severe fluctuations, poorly controlled by conventional oral drug treatment.
