Date: Thursday, June 23, 2016
Session Time: 12:00pm-1:30pm
Location: Exhibit Hall located in Hall B, Level 2
Objective: To examine the histology of subcutaneous nodules after continuous subcutaneous apomorphine infusion (CSAI).
Background: CSAI has been used successfully in advanced Parkinson’s disease (PD). However, CSAI is commonly associated with cutaneous side-effects (i.e. formation of subcutaneous nodules with or without erythema), which cause distress to patients and caregivers, and may impair drug absorption. However, the pathogenesis of these apomorphine-induced subcutaneous nodules is not fully understood.
Methods: Punch skin biopsies were taken from subcutaneous nodules in 7 patients with CSAI. The biopsies were taken with different intervals, lasting from 1 day up to several weeks after CSAI was terminated. Histologic analysis of all biopsies was performed, which was compared with 15 cases from the literature.
Results: In total, 8 biopsies were taken from subcutaneous nodules after CSAI, with a duration of infusion varying from a week to 6.5 years in 7 different PD patients. Patients’ clinical characteristics are summarized in table 1.
|Patient||Gender||Age (years)||PD duration (years)||Duration of CSAI (months)||Apomorphine dose (mg/day)||Maturity of nodule (days)||Nodule diameter (cm)|
|1||Female||68||14||66||88||Weeks to months||Plaque|
|2||Female||71||26||42||58||Weeks to months||Plaque|
|4||Female||73||7||26||132||Weeks to months||3|
Conclusions: It seems that apomorphine infusion causes an early allergic reaction, accompanied by the deposition of ortho-quinones, which are known as potent allergens. Improving the stability of the apomorphine solution very likely will reduce the formation of ortho-quinones and the prevalence of subcutaneous nodules.
To cite this abstract in AMA style:R.W.K. Borgemeester, G.F.H. Diercks, M.L.A. Schuttelaar, T. van Laar. Histology of subcutaneous nodules in PD patients treated with continuous apomorphine infusion: Case series and review of the literature [abstract]. Mov Disord. 2016; 31 (suppl 2). https://www.mdsabstracts.org/abstract/histology-of-subcutaneous-nodules-in-pd-patients-treated-with-continuous-apomorphine-infusion-case-series-and-review-of-the-literature/. Accessed September 25, 2023.
« Back to 2016 International Congress
MDS Abstracts - https://www.mdsabstracts.org/abstract/histology-of-subcutaneous-nodules-in-pd-patients-treated-with-continuous-apomorphine-infusion-case-series-and-review-of-the-literature/