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Apomorphine and diphasic dyskinesia

F Durif1, D Deffond, G Dordain

  • 1Clinique Neurologique, Hôpital Fontamaure, CHU Clermont-Ferrand, Chamalières, France.

Clinical Neuropharmacology
|February 1, 1994
PubMed
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Subcutaneous apomorphine initially reduced levodopa-induced dyskinesias in Parkinson's patients. However, effectiveness diminished over time, suggesting diurnal variations in drug response may explain these Parkinson's disease movement disorder changes.

Area of Science:

  • Neurology
  • Movement Disorders
  • Pharmacology

Background:

  • Parkinson's disease is characterized by motor symptoms that are often treated with levodopa.
  • Levodopa therapy can lead to motor complications, including diphasic dyskinesias.
  • Managing these levodopa-induced abnormal movements is a significant clinical challenge.

Observation:

  • Three patients with Parkinson's disease and levodopa-induced diphasic dyskinesias were treated with subcutaneous apomorphine.
  • Apomorphine was administered to reduce the duration of abnormal involuntary movements.
  • Initial observations focused on the efficacy of apomorphine in controlling dyskinesias.

Findings:

  • Apomorphine effectively reduced the duration of diphasic dyskinesias at higher doses (mean increase: 43%).

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  • This effect was transient, with apomorphine becoming ineffective in controlling abnormal movements after a few months, even with dose escalation.
  • Two patients experienced morning efficacy but afternoon worsening of dyskinesias with continued apomorphine treatment.

    • Implications:

    • The findings suggest that acute diurnal variations in the pharmacodynamic striatal response to apomorphine may underlie the observed clinical outcomes.
    • This highlights the complexity of managing Parkinson's disease motor fluctuations and treatment-induced side effects.
    • Further research into chronopharmacology is warranted for optimizing apomorphine therapy in Parkinson's disease.