Objective: We want to evaluate if apomorphine infusions can improve symptom control in PD patients with long standing DBS and functional decline.
Background: Deep brain stimulation (DBS) is one of the treatment options for Parkinson`s disease (PD) patients experiencing motor fluctuations and dyskinesias, not adequately to manage on oral and transdermal formulations. Since publication of data showing that young patients benefit more from STN-surgery patients undergoing DBS are rather younger and in a less advanced stage of PD. However, long-term outcomes (10yrs) of DBS show a decline of functional scores. The challenge is now how to treat patients with long-term DBS and incomplete control of symptoms. Considering the positive effects of apomorphine sc. infusions perioperatively or in preparation for DBS and after DBS removal we decided to treat patients with a combined treatment of DBS and apomorphine infusions sc.
Method: We report on 5 patients with long standing DBS and declining response. Modification of stimulation parameters and adaptation of oral medication did not lead to better control of motor symptoms. Therefore, we decided to perform an apomorphine challenge. Patients with positive apomorphine challenge were commenced on apomorphine sc infusions. Flowrate and total apomorphine dosage /day was adjusted to patient`s needs.
Results: Tab.1) Data of the patients before initiation of apomorphine
All patients showed an akinetic-rigid type of PD and experienced „off“states despite DBS. Pat. 2, 4 and 5 suffered from “off” periods after meals refractory to levodopa.
Tab. 2) Non-motor symptoms
Patient 5 suffered from nocturnal cramps and restless legs syndrome. None of the patients fulfilled the criteria of dementia and was impaired in daily life. Pat. 2 and Pat. 3 were retired, all other patients were still working and had an active life style. Therefore, “off “ periods, especially unpredictable “off”- states were disabling.
Tab. 3) 12 months after initiation of apomorphine
After implementation of combined treatment patients reported a decrease of time in “off”/day. Furthermore, quality of “on” state improved. Side effects of apomorphine sc:Pat. I: mild skin nodules
Conclusion: Apomorphine s.c. infusions can be easily tailored to patient`s needs and improved significantly symptom control in patients with long standing DBS. Thus, combined treatment of DBS and apomorphine s.c. infusions might be an option for these patients.
To cite this abstract in AMA style:
I. Reuter. Management of parkinsonian patients with long-term DBS and incomplete control of symptoms [abstract]. Mov Disord. 2020; 35 (suppl 1). https://www.mdsabstracts.org/abstract/management-of-parkinsonian-patients-with-long-term-dbs-and-incomplete-control-of-symptoms/. Accessed June 15, 2025.« Back to MDS Virtual Congress 2020
MDS Abstracts - https://www.mdsabstracts.org/abstract/management-of-parkinsonian-patients-with-long-term-dbs-and-incomplete-control-of-symptoms/