Objective: To assess the effect of continuous subcutaneous infusion of apomorphine on axial symptoms of Parkinson Disease.

Background: Axial symptoms of Parkinson’s Disease may be severe and are commonly refractory to dopaminergic treatment. A possible benefit of apomorphine has been anecdotally reported.

Method: Retrospective analysis of PD patients who started treatment with continuous subcutaneous apomorphine infusion (CSAI) in our Movement Disorders Unit.

Results: Thirteen patients, 6 female, 72±7 years old, PD duration 11±5 years, were treated with CSAI. Basal levodopa equivalent daily dose (LEDD) was 1065±519, one patient was treated with deep brain stimulation. Nine reported on-freezing, 6 frequent falls, 5 posture abnormalities, 5 camptocormia, and 4 speech problems. One female was excluded due to COVID19 decease 2 weeks from onset. Twelve were followed for 9±6 months, LEDD was reduced to 508±321 (mean 50% reduction). Freezing improved in 7, posture in 5, speech in 4, and falls in 4. No improvement of camptocormia was reported. In 8 patients motor fluctuations improved, as did on-tremor (5) and dyskinesia (3). Clinical global impression was overall positive (very much improved in 4, much improved 6, improved 1, same situation 1). Three patients discontinued treatment in the first 3 months due to inefficacy (1), incomplete benefit (1), poor compliance with the device (1). Adverse events were common but mild (skin nodules in 6, dizziness 4, hypotension 3, oedema 4, somnolence 2) and did not lead to discontinuation.

Conclusion: In our real clinical practice experience with advanced PD, many axial symptoms (especially freezing, posture and speech, but not camptocormia) improved with CSAI, which was safe and well tolerated in the long term for most patients.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/may-apomorphine-be-helpful-for-the-axial-symptoms-of-parkinsons-disease/