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Comparison of apomorphine and levodopa infusions in four patients with Parkinson's disease with symptom fluctuations.

Journal article
Authors D Nyholm
Radu Constantinescu
Björn Holmberg
N Dizdar
H Askmark
Published in Acta neurologica Scandinavica
Volume 119
Issue 5
Pages 345-8
ISSN 1600-0404
Publication year 2009
Published at Institute of Neuroscience and Physiology, Department of Clinical Neuroscience and Rehabilitation
Pages 345-8
Language en
Links dx.doi.org/10.1111/j.1600-0404.2008...
Keywords Administration, Oral, Aged, Apomorphine, administration & dosage, adverse effects, Cross-Over Studies, Dopamine Agents, administration & dosage, adverse effects, Dopamine Agonists, administration & dosage, adverse effects, Dose-Response Relationship, Drug, Drug Administration Schedule, Drug Therapy, Combination, Female, Humans, Infusion Pumps, Infusions, Subcutaneous, Levodopa, administration & dosage, adverse effects, Male, Middle Aged, Parkinson Disease, drug therapy, physiopathology, Quality of Life, Treatment Outcome
Subject categories Medical and Health Sciences

Abstract

BACKGROUND: Motor fluctuations in patients with advanced Parkinson's disease may be successfully treated with subcutaneous apomorphine infusion or intraduodenal levodopa/carbidopa infusion. No comparative trials of these two alternatives were performed. AIMS OF THE STUDY: We present a subanalysis from a randomized crossover clinical trial where levodopa infusion as monotherapy was compared with any other combination of pharmacotherapy in fluctuating patients. Four patients used apomorphine infusion and oral levodopa in the comparator arm. The results of these four patients are presented in detail. METHODS: The duration of the trial was 3 + 3 weeks. Patients were video-recorded half-hourly on two non-consecutive days of both treatment arms. Blinded video ratings were used. Patient self-assessments of motor function and quality-of-life (QoL) parameters were captured using an electronic diary. RESULTS: Ratings in moderate to severe "off" state ranged 0-44% on apomorphine infusion and 0-6% on levodopa infusion. Moderate to severe dyskinesias were not recorded in any of the treatments. QoL was reported to be improved in all patients on duodenal levodopa infusion. CONCLUSIONS: Monotherapy with duodenal infusion of levodopa was more efficacious and brought greater QoL than combination therapy with apomorphine infusion in these fluctuating patients.

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