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Comparison of apomorphine and levodopa infusions in four patients with Parkinson's disease with symptom fluctuations.
Acta Neurol Scand. 2009 May; 119(5):345-8.AN

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.

Authors+Show Affiliations

Department of Neuroscience, Neurology, Uppsala University Hospital, Uppsala, Sweden. dag.nyholm@neurologi.uu.seNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Case Reports
Comparative Study
Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

18822087

Citation

Nyholm, D, et al. "Comparison of Apomorphine and Levodopa Infusions in Four Patients With Parkinson's Disease With Symptom Fluctuations." Acta Neurologica Scandinavica, vol. 119, no. 5, 2009, pp. 345-8.
Nyholm D, Constantinescu R, Holmberg B, et al. Comparison of apomorphine and levodopa infusions in four patients with Parkinson's disease with symptom fluctuations. Acta Neurol Scand. 2009;119(5):345-8.
Nyholm, D., Constantinescu, R., Holmberg, B., Dizdar, N., & Askmark, H. (2009). Comparison of apomorphine and levodopa infusions in four patients with Parkinson's disease with symptom fluctuations. Acta Neurologica Scandinavica, 119(5), 345-8. https://doi.org/10.1111/j.1600-0404.2008.01104.x
Nyholm D, et al. Comparison of Apomorphine and Levodopa Infusions in Four Patients With Parkinson's Disease With Symptom Fluctuations. Acta Neurol Scand. 2009;119(5):345-8. PubMed PMID: 18822087.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Comparison of apomorphine and levodopa infusions in four patients with Parkinson's disease with symptom fluctuations. AU - Nyholm,D, AU - Constantinescu,R, AU - Holmberg,B, AU - Dizdar,N, AU - Askmark,H, Y1 - 2008/09/25/ PY - 2008/9/30/pubmed PY - 2009/6/27/medline PY - 2008/9/30/entrez SP - 345 EP - 8 JF - Acta neurologica Scandinavica JO - Acta Neurol Scand VL - 119 IS - 5 N2 - 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. SN - 1600-0404 UR - https://www.unboundmedicine.com/medline/citation/18822087/Comparison_of_apomorphine_and_levodopa_infusions_in_four_patients_with_Parkinson's_disease_with_symptom_fluctuations_ L2 - https://doi.org/10.1111/j.1600-0404.2008.01104.x DB - PRIME DP - Unbound Medicine ER -