Motor Fluctuations

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Parkinson's disease

Apomorphine Subcutaneous Injection for the Management of Morning Akinesia in Parkinson’s Disease

By Stuart Isaacson MD,*, Mark Lew MD, William Ondo MD, Jean Hubble MD, Thomas Clinch BS and Fernando Pagan MD

ABSTRACT Background In patients with motor fluctuations complicating Parkinson’s disease (PD), delays in time-to-ON with levodopa are common. This open-label study aimed to assess the effect of apomorphine on time-to-ON in PD patients with morning akinesia. Methods The safety population included 127 enrolled patients, and the full analysis set (FAS) included 88 patients. Patients completed…

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Effect of levodopa-carbidopa intestinal gel on dyskinesia in advanced Parkinson’s disease patients

By Angelo Antonini MD, PhD,*, Victor S. C. Fung MBBS, PhD, FRACP, James T. Boyd MD, John T. Slevin MD, MBA, Coleen Hall MS, MBA, Krai Chatamra PhD, Susan Eaton PharmD and Janet A. Benesh BSMT

The purpose of this study was to assess the effect of levodopa-carbidopa intestinal gel (carbidopa-levodopa enteral suspension) in advanced Parkinson’s disease patients with troublesome dyskinesia.

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Integrated safety of levodopa-carbidopa intestinal gel from prospective clinical trials

By Anthony E. Lang MD, FRCPC,*, Ramon L. Rodriguez MD, James T. Boyd MD, Sylvain Chouinard MD, FRCPC, Cindy Zadikoff MD, Alberto J. Espay MD, John T. Slevin MD, MBA, Hubert H. Fernandez MD, Mark F. Lew MD, David A. Stein MD, Per Odin MD, PhD, Victor S.C. Fung MBBS, PhD, FRACP, Fabian Klostermann MD, PhD, Alfonso Fasano MD, PhD, Peter V. Draganov MD, Nathan Schmulewitz MD, Weining Z. Robieson PhD, Susan Eaton PharmD, Krai Chatamra PhD, Janet A. Benesh BSMT and Jordan Dubow MD

Continuous administration of levodopa-carbidopa intestinal gel (carbidopa-levodopa enteral suspension) through a percutaneous endoscopic gastrojejunostomy is a treatment option for advanced Parkinson disease (PD) patients with motor fluctuations resistant to standard oral medications. Safety data from 4 prospective studies were integrated to assess the safety of this therapy.

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Apomorphine: A Potential Modifier of Amyloid Depositionin Parkinson’s Disease?

By Alison J. Yarnall MRCP, PhD, Tammaryn Lashley BSc, PhD, Helen Ling MRCP, PhD, Andrew J. Lees MD, FRCP, FMedSci, Shirley Y. Coleman MSc, PhD, Sean S. O'Sullivan MRCP, PhD, Yaroslau Compta MD, PhD, Tamas Revesz MD, FRCPath and David J. Burn MA, MD, FRCP*

Evidence from clinical and pathological studies suggests a role for both alpha-synuclein and amyloid-beta in the pathophysiology of dementia associated with PD. Recent work demonstrated improvement in memory and reduced amyloid-beta burden in transgenic murine Alzheimer’s models given subcutaneous apomorphine. The aim of this work was to determine whether antemortem exposure to apomorphine was associated with lower levels of amyloid-beta in brain tissue in a clinicopathological study of PD.

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New treatments for levodopa-induced motor complications

By Olivier Rascol MD, PhD*, Santiago Perez-Lloret MD, PhD and Joaquim J Ferreira MD, PhD

Levodopa (L-dopa)-induced motor complications, including motor fluctuations and dyskinesia, affect almost all patients with Parkinson’s disease (PD) at some point during the disease course, with relevant implications in global health status. Various dopaminergic and nondopaminergic pharmacological approaches as well as more invasive strategies including devices and functional surgery are available to manage such complications…

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Apomorphine Therapy: The Hazard of Left Over Needles

By Bertrand Degos MD, PhD*, Sophie Aix CRNP, Emmanuel Roze MD, PhD and Marie Vidailhet MD

A 55-year-old patient with Parkinson’s disease (PD) was seen for a shoulder abscess. This abscess was related to the presence of a subcutaneous needle that was disconnected from the tubing used for continuous apomorphine therapy…

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EuroInf: A Multicenter Comparative Observational Study of Apomorphine and Levodopa Infusion in Parkinson’s Disease

By Pablo Martinez-Martin MD, PhD, Prashanth Reddy MBBS, MRCP, Regina Katzenschlager MD, Angelo Antonini MD, PhD, Antoniya Todorova MD, PhD, Per Odin MD, PhD, Tove Henriksen MD, Anne Martin BSc, Daniela Calandrella MD, Alexandra Rizos MSc, Narissah Bryndum RN, Arne Glad RN, Haidar Salimi Dafsari MD, Lars Timmermann MD, Georg Ebersbach MD, Milica G. Kramberger MD, PhD, Michael Samuel MD, FRCP, Karoline Wenzel MD, Volker Tomantschger MD, Alexander Storch MD, Heinz Reichmann MD, Zvezdan Pirtosek MD, PhD, Maja Trost MD, PhD, Per Svenningsson MD, PhD, Sven Palhagen MD, Jens Volkmann MD, PhD and K. Ray Chaudhuri MD, DSc*

Subcutaneous apomorphine infusion (Apo) and intrajejunal levodopa infusion (IJLI) are two treatment options for patients with advanced Parkinson’s disease (PD) and refractory motor complications, with varying cost of treatment. There are no multicenter studies comparing the effects of the two strategies. This open-label, prospective, observational, 6-month, multicenter study compared…

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