Motor and non-motor effects of apomorphine infusion

Apomorphine is a medicine used in the treatment of advanced Parkinson’s disease patients. It is considered in patients who are unable to adequately control motor symptoms with oral medication. Apomorphine is a pump therapy that continuously delivers medication via a needle positioned in the subcutaneous fatty tissue. In the Netherlands, this treatment is now used for more than 20 years.
This dissertation investigated the effects of apomorphine on motor and non-motor symptoms of Parkinson’s disease in a group of patients that started treatment in the UMCG and in a group that started treatment in a specialized unit of a nursing home (now called Punt voor Parkinson). In contrary to the common perception, apomorphine is well-tolerated in Parkinson’s disease patients with cognitive dysfunction, visual hallucinations and blood pressure problems (so called orthostatic hypotension), if adequate precautions were taken. In addition, anecdotal evidence suggests a beneficial effect of apomorphine on visual hallucinations, presumably related to its chemical structure with a piperidine moiety.
The last part of this dissertation focused on local skin reactions at the site of infusion (so called subcutaneous nodules); a frequent adverse event. We investigated the underlying mechanism of subcutaneous nodules with skin biopsies and allergic testing. It is hypothesized that the occurrence of subcutaneous nodules is due to an allergic reaction, however a positive allergic test is lacking. On the other hand, treatment options were evaluated with skin biopsies showing that dilution of apomorphine and subcutaneous hydrocortisone pretreatment were most effective.