Apomorphine formulation may influence subcutaneous complications from continuous subcutaneous apomorphine infusion in Parkinson's disease

Continuous subcutaneous (s.c.) apomorphine infusion is an effective therapy for Parkinson’s disease (PD), but a limitation is the formation of troublesome s.c. nodules. Various chemically non-identical apomorphine formulations are available. Anecdotal experiences have suggested that shifting from one of these (Apo-Go PumpFill^®; apoGPF) to another (Apomorphine PharmSwed^®; apoPS) may influence the occurrence and severity of s.c. nodules. We, therefore, followed 15 people with advanced PD (median PD-duration, 15 years; median “off”-phase Hoehn and Yahr, IV) on apoGPF and with troublesome s.c. nodules who were switched to apoPS. Data were collected at baseline, at the time of switching, and at a median of 1, 2.5, and 7.3 months post-switch. Total nodule numbers (P < 0.001), size (P < 0.001), consistency (P < 0.001), skin changes (P = 0.058), and pain (P ≤ 0.032) improved over the observation period. PD severity and dyskinesias tended to improve and increase, respectively. Apomorphine doses were stable, but levodopa doses increased by 100 mg/day. Patient-reported apomorphine efficacy tended to increase and all participants remained on apoPS throughout the observation period; with the main patient-reported reason being improved nodules. These observations suggest that patients with s.c. nodules caused by apoGPF may benefit from switching to apoPS in terms of s.c. nodule occurrence and severity. Alternatively, observed benefits may have been due to the switch itself. As nodule formation is a limiting factor in apomorphine treatment, a controlled prospective study comparing local tolerance with different formulations is warranted.

Parkinson-plus patients--an unknown group with severe symptoms

The Parkinson-plus syndromes, which include multiple system atrophy (MSA), progressive supranuclear palsy (PSP), and corticobasal degeneration (CBD), are still not well-known. Research concerning diagnosis and treatment is ongoing; nursing studies are lacking. Therefore, the aims of this study were to survey the patients about their symptoms, their previous contacts with physicians and other caregivers, the questions about their disease that were of most importance to them, and their perceived quality of life. The mapping caregivers and symptoms (MCAS) questionnaire, which was constructed for the study, and the Nottingham Health Profile (NHP), were used. Twenty-three patients participated. Early in the course of the disease Parkinson-plus patients needed to consult physicians from different specialties and many other professional caregivers because of a multitude of problems such as slow movements, weak voice, stiffness, dysphagia, muscle pain, and incontinence. The NHP revealed that many participants ran out of energy, and this affected their everyday lives and leisure time. As the disease progressed, palliative needs successively increased. Patients in all stages wanted to know about the disease course and their prognosis and about issues that could give them hope. In accordance with palliative care philosophy, caregivers can help direct the patients' hope from cure to a palliative goal, with a focus on quality of life.