[Apomorphine in the treatment of Parkinson disease]

In later stages of the disease, patients with Parkinson's disease treated with levodopa may become severely disabled by pronounced and sudden motor fluctuations called "the on-off syndrome". In spite of optimal individual adjustment of doses and combinations, orally administered antiparkinson drugs are often not able to eliminate the off-conditions which may last from minutes to hours and sometimes are accompanied by dystonic pain. Apomorphine, a potent dopamine receptor agonist, administered subcutaneously as single injections or continuously by means of a pump, quickly passes on to striatal dopamine receptors. With suitable individually adjusted doses, a rapid, and in some cases, more stable anti-parkinson effect may be achieved. Peripheral side-effects can be avoided by concomitant treatment with domperidone. Nine levodopa treated patients with Parkinson's disease and severe on-off syndrome received apomorphine. Seven experienced considerable and long-term improvement of the disabling symptoms, and some patients reduction of levodopa and/or bromocriptine doses. Treatment with apomorphine should only be considered in patients whose on-conditions are not accompanied by pronounced dyskinesias and/or impairment of balance or to patients suffering from severe dystonic pain.