Objective: Investigation on Parkinson’s patients with therapy-resistant tremor using
apomorphine-pen injection for alleviation of resting tremor.

Background: In Parkinson’s disease one of the major disturbing symptoms is resting tremor. The tremor is of
great disturbance to the patients with additional stigma. Tremor is often found to be therapy
resistant in spite of optimal or80al treatment with tablets. Although medication is stated to
influence tremors, an increment in medication in order to alleviate the tremor often produces no
effect.

Method: 12 patients with idiopathic Parkinson’s disease suffering from therapy-resistant resting tremor
were included into the study. The patient population comprised 9 men, 4 women. H/Y I-II Age
mean 56-.74 Disease duration was over 2 years. All patients were on regular Parkinson medication when tested and physically independent.
Prior to the Apomorphine test, patients were medicated for three days with domperidone 10 mg
t.i.d. Patients underwent a standard Apomorphine Pen test with 1 mg up-titration to an
acceptable level of effect not exceeding 5 mg. Patients were monitored before and after the test
using UPDRS part II and III and video recordings of the results. A standard follow-up was
scheduled. Dropouts and side effects were recorded.

Results: All patients experienced a profound effect of Apomorphine Pen treatment. 2 patients discontinued at the test because of nausea/dizziness. 5 discontinued after some weeks leaving a dropout rate 50%. Drop-outs were due to nausea, tiredness, too short an effect of medication, and discomfort with injections. 6 patients continued treatment with stable and continuous effects of medication. Effect duration was 1-2.5 hours. Dosage used was 1.5-4 mg.

Conclusion: The test with apomorphine-Pen therapy showed that all patients experienced a benefit from Pen injection on alleviating the therapy-resistant tremor. The reduction was found in all
patients and the reduction of tremors was profound. Although effective in reduction of tremor cessation of further apomorphine-Pen therapy was found in many of the patients due to immediate side effects. Other patients stopped Pen therapy after some time due to nausea, tiredness, or too short duration of effect of the Pen treatment. Interventions for reducing dropouts are needed. The use of apomorphine pumps, for extension of effect time and reduction of side effects, may solve these limitations.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/therapy-resistant-tremor-in-parkinsons-disease-satisfying-an-unmet-need/