Apomorphine monotherapy in the treatment of refractory motor complications of Parkinson's disease: long-term follow-up study of 64 patients.
Identifieur interne : 000934 ( Ncbi/Checkpoint ); précédent : 000933; suivant : 000935Apomorphine monotherapy in the treatment of refractory motor complications of Parkinson's disease: long-term follow-up study of 64 patients.
Auteurs : Alice J. Manson [Royaume-Uni] ; Kirsten Turner ; Andrew J. LeesSource :
- Movement disorders : official journal of the Movement Disorder Society [ 0885-3185 ] ; 2002.
English descriptors
- KwdEn :
- Adult, Aged, Antiparkinson Agents (administration & dosage), Antiparkinson Agents (adverse effects), Apomorphine (administration & dosage), Apomorphine (adverse effects), Dose-Response Relationship, Drug, Drug Administration Schedule, Drug Therapy, Combination, Dyskinesia, Drug-Induced (diagnosis), Dyskinesia, Drug-Induced (drug therapy), Female, Humans, Infusion Pumps, Levodopa (administration & dosage), Levodopa (adverse effects), Long-Term Care, Male, Middle Aged, Parkinson Disease (diagnosis), Parkinson Disease (drug therapy), Treatment Outcome.
- MESH :
- chemical , administration & dosage : Antiparkinson Agents, Apomorphine, Levodopa.
- chemical , adverse effects : Antiparkinson Agents, Apomorphine, Levodopa.
- diagnosis : Dyskinesia, Drug-Induced, Parkinson Disease.
- drug therapy : Dyskinesia, Drug-Induced, Parkinson Disease.
- Adult, Aged, Dose-Response Relationship, Drug, Drug Administration Schedule, Drug Therapy, Combination, Female, Humans, Infusion Pumps, Long-Term Care, Male, Middle Aged, Treatment Outcome.
Abstract
Continuous subcutaneous infusion of apomorphine is now increasingly recognized as an effective treatment for refractory off periods and peak-dose dyskinesias in Parkinson's disease. We have reviewed our experience with apomorphine infusions, after a strategy decision in 1995 based on emerging preclinical data, to treat all patients with steady-state plasma levels of apomorphine throughout the waking day, minimizing additional pulsatile stimulation either by oral dopaminergic medication or bolus parenteral injections of apomorphine. Sixty-four patients have been treated with apomorphine pumps and 45 of these successfully converted to monotherapy, managing to discontinue all other forms of dopaminergic stimulation during the daytime treatment period with apomorphine. Patients were followed up for a mean of 33.8 months (range, 4-108 months) and clinical data analyzed retrospectively. The mean maintenance dose of apomorphine was 98 mg per 24 hours (monotherapy group: 103 mg/24 hours; polytherapy group: 93 mg/24 hours), which did not significantly increase at final follow-up. There was a mean maximum dyskinesia reduction of 64% (S.D. = 20) in the monotherapy group, compared to 30% (S.D. = 33) in those continuing on polytherapy (P < 0.001), despite a maintained increase in on time (monotherapy group: 55%, P < 0.005; polytherapy group: 50%, P = 0.05). Fifteen patients failed to successfully convert to monotherapy but benefited nonetheless, and only 3 failed apomorphine infusional therapy altogether. Reasons for failure were mixed, including difficulty with compliance and adverse effects such as daytime somnolence, skin complications, and painful dystonias. There was a significantly higher success rate in patients able to manage the treatment either independently or with the help of their caregiver. These results confirm that subcutaneous apomorphine monotherapy can reset peak-dose dyskinesia threshold in levodopa-treated patients and further reduce off-period disability after all available forms of oral medication, including long-acting dopamine agonists, have been tried.
DOI: 10.1002/mds.10281
PubMed: 12465062
Affiliations:
Links toward previous steps (curation, corpus...)
- to stream PubMed, to step Corpus: 003917
- to stream PubMed, to step Curation: 003917
- to stream PubMed, to step Checkpoint: 003B92
- to stream Ncbi, to step Merge: 000934
- to stream Ncbi, to step Curation: 000934
Links to Exploration step
pubmed:12465062Le document en format XML
<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Apomorphine monotherapy in the treatment of refractory motor complications of Parkinson's disease: long-term follow-up study of 64 patients.</title>
<author><name sortKey="Manson, Alice J" sort="Manson, Alice J" uniqKey="Manson A" first="Alice J" last="Manson">Alice J. Manson</name>
<affiliation wicri:level="3"><nlm:affiliation>The Reta Lila Weston Institute for Neurological Studies, The Middlesex Hospital, London, United Kingdom.</nlm:affiliation>
<country xml:lang="fr">Royaume-Uni</country>
<wicri:regionArea>The Reta Lila Weston Institute for Neurological Studies, The Middlesex Hospital, London</wicri:regionArea>
<placeName><settlement type="city">Londres</settlement>
<region type="country">Angleterre</region>
<region type="région" nuts="1">Grand Londres</region>
</placeName>
</affiliation>
</author>
<author><name sortKey="Turner, Kirsten" sort="Turner, Kirsten" uniqKey="Turner K" first="Kirsten" last="Turner">Kirsten Turner</name>
</author>
<author><name sortKey="Lees, Andrew J" sort="Lees, Andrew J" uniqKey="Lees A" first="Andrew J" last="Lees">Andrew J. Lees</name>
</author>
</titleStmt>
<publicationStmt><idno type="wicri:source">PubMed</idno>
<date when="2002">2002</date>
<idno type="RBID">pubmed:12465062</idno>
<idno type="pmid">12465062</idno>
<idno type="doi">10.1002/mds.10281</idno>
<idno type="wicri:Area/PubMed/Corpus">003917</idno>
<idno type="wicri:Area/PubMed/Curation">003917</idno>
<idno type="wicri:Area/PubMed/Checkpoint">003B92</idno>
<idno type="wicri:Area/Ncbi/Merge">000934</idno>
<idno type="wicri:Area/Ncbi/Curation">000934</idno>
<idno type="wicri:Area/Ncbi/Checkpoint">000934</idno>
</publicationStmt>
<sourceDesc><biblStruct><analytic><title xml:lang="en">Apomorphine monotherapy in the treatment of refractory motor complications of Parkinson's disease: long-term follow-up study of 64 patients.</title>
<author><name sortKey="Manson, Alice J" sort="Manson, Alice J" uniqKey="Manson A" first="Alice J" last="Manson">Alice J. Manson</name>
<affiliation wicri:level="3"><nlm:affiliation>The Reta Lila Weston Institute for Neurological Studies, The Middlesex Hospital, London, United Kingdom.</nlm:affiliation>
<country xml:lang="fr">Royaume-Uni</country>
<wicri:regionArea>The Reta Lila Weston Institute for Neurological Studies, The Middlesex Hospital, London</wicri:regionArea>
<placeName><settlement type="city">Londres</settlement>
<region type="country">Angleterre</region>
<region type="région" nuts="1">Grand Londres</region>
</placeName>
</affiliation>
</author>
<author><name sortKey="Turner, Kirsten" sort="Turner, Kirsten" uniqKey="Turner K" first="Kirsten" last="Turner">Kirsten Turner</name>
</author>
<author><name sortKey="Lees, Andrew J" sort="Lees, Andrew J" uniqKey="Lees A" first="Andrew J" last="Lees">Andrew J. Lees</name>
</author>
</analytic>
<series><title level="j">Movement disorders : official journal of the Movement Disorder Society</title>
<idno type="ISSN">0885-3185</idno>
<imprint><date when="2002" type="published">2002</date>
</imprint>
</series>
</biblStruct>
</sourceDesc>
</fileDesc>
<profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Adult</term>
<term>Aged</term>
<term>Antiparkinson Agents (administration & dosage)</term>
<term>Antiparkinson Agents (adverse effects)</term>
<term>Apomorphine (administration & dosage)</term>
<term>Apomorphine (adverse effects)</term>
<term>Dose-Response Relationship, Drug</term>
<term>Drug Administration Schedule</term>
<term>Drug Therapy, Combination</term>
<term>Dyskinesia, Drug-Induced (diagnosis)</term>
<term>Dyskinesia, Drug-Induced (drug therapy)</term>
<term>Female</term>
<term>Humans</term>
<term>Infusion Pumps</term>
<term>Levodopa (administration & dosage)</term>
<term>Levodopa (adverse effects)</term>
<term>Long-Term Care</term>
<term>Male</term>
<term>Middle Aged</term>
<term>Parkinson Disease (diagnosis)</term>
<term>Parkinson Disease (drug therapy)</term>
<term>Treatment Outcome</term>
</keywords>
<keywords scheme="MESH" type="chemical" qualifier="administration & dosage" xml:lang="en"><term>Antiparkinson Agents</term>
<term>Apomorphine</term>
<term>Levodopa</term>
</keywords>
<keywords scheme="MESH" type="chemical" qualifier="adverse effects" xml:lang="en"><term>Antiparkinson Agents</term>
<term>Apomorphine</term>
<term>Levodopa</term>
</keywords>
<keywords scheme="MESH" qualifier="diagnosis" xml:lang="en"><term>Dyskinesia, Drug-Induced</term>
<term>Parkinson Disease</term>
</keywords>
<keywords scheme="MESH" qualifier="drug therapy" xml:lang="en"><term>Dyskinesia, Drug-Induced</term>
<term>Parkinson Disease</term>
</keywords>
<keywords scheme="MESH" xml:lang="en"><term>Adult</term>
<term>Aged</term>
<term>Dose-Response Relationship, Drug</term>
<term>Drug Administration Schedule</term>
<term>Drug Therapy, Combination</term>
<term>Female</term>
<term>Humans</term>
<term>Infusion Pumps</term>
<term>Long-Term Care</term>
<term>Male</term>
<term>Middle Aged</term>
<term>Treatment Outcome</term>
</keywords>
</textClass>
</profileDesc>
</teiHeader>
<front><div type="abstract" xml:lang="en">Continuous subcutaneous infusion of apomorphine is now increasingly recognized as an effective treatment for refractory off periods and peak-dose dyskinesias in Parkinson's disease. We have reviewed our experience with apomorphine infusions, after a strategy decision in 1995 based on emerging preclinical data, to treat all patients with steady-state plasma levels of apomorphine throughout the waking day, minimizing additional pulsatile stimulation either by oral dopaminergic medication or bolus parenteral injections of apomorphine. Sixty-four patients have been treated with apomorphine pumps and 45 of these successfully converted to monotherapy, managing to discontinue all other forms of dopaminergic stimulation during the daytime treatment period with apomorphine. Patients were followed up for a mean of 33.8 months (range, 4-108 months) and clinical data analyzed retrospectively. The mean maintenance dose of apomorphine was 98 mg per 24 hours (monotherapy group: 103 mg/24 hours; polytherapy group: 93 mg/24 hours), which did not significantly increase at final follow-up. There was a mean maximum dyskinesia reduction of 64% (S.D. = 20) in the monotherapy group, compared to 30% (S.D. = 33) in those continuing on polytherapy (P < 0.001), despite a maintained increase in on time (monotherapy group: 55%, P < 0.005; polytherapy group: 50%, P = 0.05). Fifteen patients failed to successfully convert to monotherapy but benefited nonetheless, and only 3 failed apomorphine infusional therapy altogether. Reasons for failure were mixed, including difficulty with compliance and adverse effects such as daytime somnolence, skin complications, and painful dystonias. There was a significantly higher success rate in patients able to manage the treatment either independently or with the help of their caregiver. These results confirm that subcutaneous apomorphine monotherapy can reset peak-dose dyskinesia threshold in levodopa-treated patients and further reduce off-period disability after all available forms of oral medication, including long-acting dopamine agonists, have been tried.</div>
</front>
</TEI>
<affiliations><list><country><li>Royaume-Uni</li>
</country>
<region><li>Angleterre</li>
<li>Grand Londres</li>
</region>
<settlement><li>Londres</li>
</settlement>
</list>
<tree><noCountry><name sortKey="Lees, Andrew J" sort="Lees, Andrew J" uniqKey="Lees A" first="Andrew J" last="Lees">Andrew J. Lees</name>
<name sortKey="Turner, Kirsten" sort="Turner, Kirsten" uniqKey="Turner K" first="Kirsten" last="Turner">Kirsten Turner</name>
</noCountry>
<country name="Royaume-Uni"><region name="Angleterre"><name sortKey="Manson, Alice J" sort="Manson, Alice J" uniqKey="Manson A" first="Alice J" last="Manson">Alice J. Manson</name>
</region>
</country>
</tree>
</affiliations>
</record>
Pour manipuler ce document sous Unix (Dilib)
EXPLOR_STEP=$WICRI_ROOT/Wicri/Santé/explor/MovDisordV3/Data/Ncbi/Checkpoint
HfdSelect -h $EXPLOR_STEP/biblio.hfd -nk 000934 | SxmlIndent | more
Ou
HfdSelect -h $EXPLOR_AREA/Data/Ncbi/Checkpoint/biblio.hfd -nk 000934 | SxmlIndent | more
Pour mettre un lien sur cette page dans le réseau Wicri
{{Explor lien |wiki= Wicri/Santé |area= MovDisordV3 |flux= Ncbi |étape= Checkpoint |type= RBID |clé= pubmed:12465062 |texte= Apomorphine monotherapy in the treatment of refractory motor complications of Parkinson's disease: long-term follow-up study of 64 patients. }}
Pour générer des pages wiki
HfdIndexSelect -h $EXPLOR_AREA/Data/Ncbi/Checkpoint/RBID.i -Sk "pubmed:12465062" \ | HfdSelect -Kh $EXPLOR_AREA/Data/Ncbi/Checkpoint/biblio.hfd \ | NlmPubMed2Wicri -a MovDisordV3
This area was generated with Dilib version V0.6.23. |