Using Subcutaneous Injections of Apomorphine to Control Off Periods in Parkinson's Disease

The patient is a 76-year-old man with a 26 year history of Parkinson's disease who developed prominent motor fluctuations. He was treated with levodopa-carbidopa, amantadine, pramipexole, and entacapone. Despite these various adjunctive medications, he continued to have severely disabling spontaneous off events characterized by profound bradykinesia. During these events, he was non-ambulatory. Subcutaneous apomorphine was prescribed and adjusted to a dose of 0.4 cc (4 mg) injections, given as needed for off states. The patient responded to this treatment, enjoying recovery from off states within 5 minutes of injection with all injections being effective. After six years, he continues to use apomorphine injections 3-5 times daily for spontaneous offs with a marked improvement in his quality of life and a renewed confidence in his ability to remain mobile during activities of daily living.

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Learning objectives: After reading this case, the participant should be able to...

1. Assess the presence, characteristics, and duration of "off" time in Parkinson's disease
2. Discuss treatment options for reduction of off time
3. Describe the use of apomorphine for the acute, intermittent treatment of off episodes associated with advanced Parkinson's disease

The content of WE MOVE case studies in the Movement Disorder Virtual University is based on the professional experience of the case authors. All diagnostic procedures and treatments were the choice of the treating physicians based on their extensive experience.

WE MOVE thanks Richard B. Dewey, Jr., MD for this case submission.

Richard B. Dewey, Jr., MD
Associate Professor of Neurology
UT Southwestern Medical Center at Dallas

Disclosure statement
Dr. Dewey has received honoraria for speaking programs from GlaxoSmithKline, Bertek, Novartis, Teva and Boehringer Ingelheim. He is a consultant to GlaxoSmithKline.

The content of this case represents the personal clinical experience and opinion of the author who is an expert in the diagnosis and treatment of Parkinson's disease.