Objective: To demonstrate the use of subcutaneous(SC) apomorphine injections in suspected untreated dopamine responsive conditions.
Background: Apomorphine is a dopamine agonist historically used in dopamine challenges in movement disorders. Currently, it is available in several formulations and is mainly indicated for use as rescue therapy in Parkinson’s Disease.
Method: We describe 2 cases where SC apomorphine injections were used to 1)assess for dopamine responsiveness in acute conditions, 2)provide acute relieve in symptoms and 3)act as parenteral bridging therapy while levodopa is titrated.
Results: Case 1: A 18-year-old levodopa naïve patient with a history of spastic dystonic cerebral palsy on intrathecal baclofen presented with increasing frequency of dystonic episodes in the setting of an unknown source of infection. The patient received clonazepam, trihexyphenidyl and eventually required admission to the critical care unit for propofol infusion. SC apomorphine injection was tried, which brought about immediate relief in symptoms. The patient was then placed on regular SC apomorphine while levodopa was titrated over days. As the infection subsided, the patient was weaned off apomorphine and placed on regular levodopa indefinitely.
Case 2: A 20-year-old male with previous traumatic brain injury from a motor vehicle accident 2 years ago presented with subacute onset of paroxysmal tremulousness of the bilateral upper limbs and dystonic posturing of his arms and legs. He was in a minimally conscious state prior to admission, able to respond to simple ‘yes’ ‘no’ answers to questions and exhibit some awareness of his surroundings. We suspected post-traumatic parkinsonism and opted to start dopaminergic therapy. The introduction of SC apomorphine achieved immediate and significant relief of his symptoms. Oral levodopa treatment was complicated by continuous enteral feeding. The patient remained on SC apomorphine while levodopa therapy was titrated. The patient eventually remained stable on levodopa monotherapy.
Conclusion: SC apomorphine injection is a robust treatment tool for relief of acute dopamine-responsive movement disorders, predictor for dopamine response as well as parenteral bridging therapy while maintenance levodopa is titrated. Apomorphine should be considered amongst treatment options in the acute setting.
To cite this abstract in AMA style:S. Bansal, JR. Chai, M. Jog. Expanding the armamentarium of clinical use of apomorphine in movement disorders. [abstract]. Mov Disord. 2022; 37 (suppl 2). https://www.mdsabstracts.org/abstract/expanding-the-armamentarium-of-clinical-use-of-apomorphine-in-movement-disorders/. Accessed March 4, 2024.
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MDS Abstracts - https://www.mdsabstracts.org/abstract/expanding-the-armamentarium-of-clinical-use-of-apomorphine-in-movement-disorders/