Objective: The aim of the study was to assess the long-term effect of subcutaneous infusions of apomorphine in the treatment of camptocormia in advanced Parkinson’s disease (PD).

Background: Camptocormia in PD responds poorly to botulinum toxin injections, manipulation with dopaminergic treatment or deep brain stimulation. The results of our previous pilot study showed good therapeutic effect of subcutaneous apomorphine infusions in a small cohort of patients.

Method: 11 patients with Parkinson´s disease, who developed camptocormia, were treated with subcutaneous apomorphine infusion and followed-up for the period of 2 years. All patients were treated with L-DOPA and dopaminergic agonists at the time when camptocormia appeared; none of them improved following the manipulation of dopaminergic treatment or application of botulinum toxin injections. In the case of positive response to apomorphine challenge (i.e. substantial improvement of camptocormia), the treatment by continuous subcutaneous infusions of apomorphine was initiated. Apomorphine dose was gradualy titrated, according to the clinical response and tolerance, up to daily dose ranging from 40 to 70 mg. All patients were regularly monitored over a 24-month follow-up period.

Results: The camptocormia improved in all patients after four weeks of continuous apomorphine treatment, and this effect remained stable over the whole follow-up period in 10 of them. In one patient, the therapy was discontinued due to loss of effect after one year; the patient later developed the clinical phenotype MSA-P type. The side effects in all patients were rare and not serious.

Conclusion: Apomorphine hydrochloride in the form of continuous subcutaneous infusion can be successfuly and safety used for the long-term treatment of camptocormia in the advanced stage of Parkinson´s disease. Supported by: grant from the Ministry of Health, Czech Republic – conceptual development of research organization – MH CZ – DRO (FNOL, 00098892) 2019.

References: Mensikova K, Kaiserova M, Vastik M et al. Treatment of camptocormia with continuous soubcutaneous infusions of apomorphine: 1-year prospective pilot study. J Neural Transm 2015; 122: 835-839.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/the-long-term-effect-of-continuous-apomorphine-treatment-on-camptocormia-in-parkinsons-disease-a-24-months-longitudinal-open-prospective-follow-up-study/