Objective: To assess the prevalence of impulsive compulsive behaviours (ICBs) in Parkinson’s disease who donated their brains and used apomorphine infusion in life.

Background: Impulsive compulsive behaviours (ICBs) are potentially severe complications from dopaminergic treatment that can arise in patients with Parkinson’s disease. It has been postulated that constant dopaminergic stimulation is associated with lower risk of ICBs. To investigate this, we have studied a group of PD patients from the Queen Square Brain Bank that received apomorphine via continuous infusion in life to assess the prevalence and outcome of ICBs.

Method: We conducted a search on the QSBB database for cases donated between 2005 to 2016 with a pathological diagnosis of idiopathic Parkinson’s disease. We reviewed the notes of all donors who used apomorphine via continuous infusion for at least 3 months. Clinical and demographic data were collected, as well as detailed information on treatment, and prevalence and outcomes of ICBs. Data was analysed using SPSS22.

Results: We have identified 193 PD cases, 124 males and 69 females, with an average age at disease onset of 60.2 years and average disease duration of 17.2 years. The prevalence of ICBs was 14.5%. Twenty-four individuals used apomorphine infusion for more than 3 months. The patients on apomorphine had younger age at disease onset, longer disease duration and higher prevalence of dyskinesias. The prevalence of de novo ICB cases on the APO+ group was 8.3%, among these all but one patient had been exposed to oral dopamine agonists and all to levodopa. Apomorphine infusion was used for an average of 63.1 months on an average maximum dose of 79.5 mg per day. Ten patients remained on apomorphine until death. Dementia occurred in nearly half of the entire cohort, depression in one quarter and dyskinesias in a little over 40%.

Conclusion: Apomorphine appears to be a safe treatment option for patients with previous ICBs but is associated with de novo ICBs in approximately 8% of patients who had been previously exposed to oral DA and/or levodopa.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/the-prevalence-of-icbs-in-patients-treated-with-apomorphine-infusion-a-retrospective-analysis/