Objective: To describe the benefit of continuous subcutaneous apomorphine infusion (CSAI) for terminal care management in 7 PD patients.
Background: There are currently no recommendations for the therapeutic management of Parkinson’s disease (PD) at the end of life. Progressive or sudden inaccessibility of the oral route is frequent at this stage and may result in complications such as aspiration pneumonia or the Parkinsonism-Hyperpyrexia Syndrome (PHS). These potentially fatal outcomes also considerably worsen the quality of life of PD patients and their relatives.
Method: We retrospectively collected clinical data from 7 PD patients for whom CSAI was initiated in the context of terminal care. We analyzed the patient’s comfort, analgesic and sedative drugs consumption, as well as the caregiver’s burden. We also recorded side effects related to CSAI (subcutaneous nodules, nausea, neuropsychiatric symptoms worsening).
Results: All patients had a diffuse PD phenotype with severe motor and cognitive decline and dysphagia. Precipitating factors for end of life care were identified in all cases. Patients received CSAI for terminal care at low dosages (<3mg per hour) over 24 hours either at home or in care services. CASI was combined with neurological and palliative follow-up under the supervision of the PD nurse. Duration of treatment was between 2 and 10 days. In all cases, CSAI at low dosages markedly improved patient comfort (particularly axial rigidity and pain) and caregiver’s burden. CASI also diminished analgesic and sedative consumption and allowed some patients to communicate with their relatives until death. No serious adverse events were noticed.
Conclusion: In our case series, CSAI at low dosages was of great interest in PD terminal care for both patient’s comfort and caregiver’s burden, without serious adverse events. Thus, the palliative use of CSAI deserved to be more widely investigated in the next future.
To cite this abstract in AMA style:M. Bereau, M. Giffard, AL. Clairet, M. Verin, M. Auffret. Continuous subcutaneous apomorphine infusion for the management of Parkinson’s disease at the end-of-life [abstract]. Mov Disord. 2022; 37 (suppl 2). https://www.mdsabstracts.org/abstract/continuous-subcutaneous-apomorphine-infusion-for-the-management-of-parkinsons-disease-at-the-end-of-life/. Accessed March 4, 2024.
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MDS Abstracts - https://www.mdsabstracts.org/abstract/continuous-subcutaneous-apomorphine-infusion-for-the-management-of-parkinsons-disease-at-the-end-of-life/