Session Information
Date: Tuesday, June 6, 2017
Session Title: Therapy in Movement Disorders
Session Time: 1:45pm-3:15pm
Location: Exhibit Hall C
Objective: To propose a new apomorphine challenge test
Background: In the standard apomorphine challenge test, the appropriate dose of apomorphine is established by incremental dosing schedules. This test is time consuming, usually causes an important discomfort, and apomorphine may accumulate in serum. We propose a new one, shorter, less troublesome and pragmatic.
Methods: Patients: Non demented PD patients with motor fluctuations insufficient controlled with oral or transdermal drugs, able to perform the test, or with an appropriate caregiver. Challenge test: Administer domperidone 10 mg tid since 4 days before, and upon arriving at the office the day of the test. Evaluation: check OFF status and UPDRS-III. Initial apomorphine dose was 3 mg ( 2mg < 45 kg; 4 mg > 90 kg; 1 mg in case of a history of dysautonomia) Effect: check turning into ON. If patient improves, we maintain that dose. If he or she does not improve, we prescribe one more mg to be used at home. Measures: Age, sex, age at onset, years with PD and treatment. Hoehn and Yahr, UPDRS-III, Clinical Impression of Severity Index. Apomorphine dose, time to ON, adverse events (AE). At six months: dose and number of injections per day
Results: 79 PD patients (49 men), mean age 61,2±23,4 years (range 30-84); age at onset 50,8±22,8 years (range 24-77); H&Y 3,1±1,1 (42 II- 23 III – 14 IV); UPDRS III OFF 42,3±11,4 (range 28-72); UPDRS III ON 26,4 ± 8,7 (9-41). All were treated with levodopa (659,2±274,1 mg), 61 with dopamine agonists (DA), 13 amantadine, 27 rasagiline, 57 COMTi; total levodopa dose equivalent 894.2 ± 388.4 mg. Prior intolerance to DA, 8 patients. Responses: worse, 5 (side effects); no effect: 8; better, incomplete response, 25; complete response, 41. Time to ON (complete responses, n=41) 7,3 ± 3,8 min; range 3,2 – 21,8 min. Test time consuming: 22,6 ± 7,4 min (range 16-35). AE: Mild in 22 patients (27,8%) (nausea: 17, dizziness: 16, headache: 6, untroublesome dyskinesias: 3, yawning: 63); and severe in 5 (6,3%)(vomiting: 2, hypotension: 4, (all 4 have prior intolerance to DA), and troublesome dyskinesias 1. All AE appeared in the first 12 min. At six months: 61 (77,2%) patients continued using apomorphine. The final dose was 5,6 ± 2,3 mg (3-9), the number of injections per day 2,2 ± 1,3 (0-5). No important AE were reported on follow-up
Conclusions: The proposed apomorphine challenge test is reliable, easy to use and saves a lot of time and discomfort to patients, nurses and physicians.
To cite this abstract in AMA style:
J.C. Martinez Castrillo, A. Alonso Canovas, C. Estevez Fraga, G. Sanchez Diez, I. Avilés Olmos, J. Lopez Sendon, P. Garcia Ruiz, L. Vela Desojo. Alternative Apomorphine Challenge Test [abstract]. Mov Disord. 2017; 32 (suppl 2). https://www.mdsabstracts.org/abstract/alternative-apomorphine-challenge-test/. Accessed June 14, 2025.« Back to 2017 International Congress
MDS Abstracts - https://www.mdsabstracts.org/abstract/alternative-apomorphine-challenge-test/