Intermittent Apomorphine Injection Therapy in an Advanced Parkinson's Disease Patient with Early Morning Delayed-On

This is a 74 year old man with a nine year history of Parkinson's disease, initially treated with a dopamine agonist, who has had motor fluctuations, dyskinesias, and painful early-morning leg cramping for three years. In an effort to reduce his total daily dosages of pramipexole and levodopa, he began injecting apomorphine. After some time, he found he was able to successfully alleviate his early morning discomfort each morning, and uses intermittent injections rarely for unanticipated off-periods during the day, although he continues to have occasional problems with medication-induced nausea. In addition, he was also able to manage his motor disability with apomorphine only, during an NPO period associated with colonoscopy.

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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 Mark Stacy, MD for this case submission.

Mark Stacy, MD
Director, Parkinson's Disease and Movement Disorders Center
Duke University Medical School
Durham, NC 27705

Disclosure statement
Dr. Stacy has been a consultant to Bertek Pharmaceuticals in the past.

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.