Zusammenfassung
Apomorphin ist ein Non-Ergot-Dopaminagonist, dessen therapeutische
Wirksamkeit auf die Kardinalsymptome der Parkinsonkrankheit seit über 100
Jahren bekannt ist. Die subkutane Injektion von Apomorphin wird seit Ende der
80er-Jahre zu diagnostischen Zwecken durchgeführt. Der sog. Apomorphintest
kann die Beurteilung der Effektivität einer dopaminergen Therapie sowie
die Diagnoseüberprüfung bei Patienten mit neu aufgetretenem oder
atypisch verlaufendem Parkinsonsyndrom unterstützen. Dieser Beitrag stellt
die klinische Anwendung des Apomorphintests sowie die Ergebnisse einer
Metaanalyse und eines systematischen Reviews zur diagnostischen Wertigkeit des
Apomorphintests, auch im Vergleich zum akuten L-Dopa-Test und der chronischen
L-Dopa-Anwendung vor.
Abstract
Apomorphine is a powerful, non-ergot dopamine agonist and its
therapeutical efficacy on the cardinal motor symptoms of Parkinson's
disease has been known for more than 100 years. In the late 1980s the
subcutaneous injection of apomorphine was introduced in the assessment of
Parkinsonian patients. This acute challenge test used to be advocated as being
helpful in improving the clinical diagnostic accuracy of Parkinson's
disease and in predicting the dopaminergic responsiveness as part of a
pre-treatment assessment. We summarise here the clinical management of the
apomorphine test as well as the results of a meta-analysis and a systematic
review on the diagnostic value of apomorphine in Parkinsonian patients.
Schlüsselwörter
Apomorphin - Apomorphintest - diagnostische Wertigkeit
Keywords
apomorphine - apomorphine test - diagnostic value
Literatur
-
1
Gancher S T, Woodward W R, Boucher B et al.
Peripheral pharmacokinetics of apomorphine in humans.
Ann Neurol.
1989;
26
232-238
-
2
Barker R, Duncan J, Lees A J.
Subcutaneous apomorphine as a diagnostic test for
dopaminergic responsiveness in Parkinsonian syndromes.
Lancet.
1989;
1
675-678
-
3
Oertel W H, Gasser T, Ippisch R et al.
Apomorphine test for dopaminergic responsiveness.
Lancet.
1989;
1
1262-1263
-
4
Hughes A J, Lees A J, Stern G M.
Apomorphine test to predict dopaminergic responsiveness in
parkinsonian syndromes.
Lancet.
1990;
336
32-34
-
5
D’Costa D F, Abbott R J, Pye I F et al.
The apomorphine test in parkinsonian syndromes.
J Neurol Neurosurg Psychiatry.
1991;
54
870-872
-
6
Hughes A J, Lees A J, Stern G M.
Challenge tests to predict the dopaminergic response in
untreated Parkinson’s disease.
Neurology.
1991;
41
1723-1725
-
7
Bonuccelli U, Piccini P, Del Dotto P et al.
Apomorphine test in De novo Parkinson’s disease.
Funct Neurol.
1992;
7
295-298
-
8
Gasser T, Schwarz J, Arnold G et al.
Apomorphine test for dopaminergic responsiveness in patients
with previously untreated Parkinson’s disease.
Arch Neurol.
1992;
49
1131-1134
-
9
Bonuccelli U, Piccini P, Del Dotto P et al.
Apomorphine test for dopaminergic responsiveness: a dose
assessment study.
Mov Disord.
1993;
8
158-164
-
10
Schelosky L, Hierholzer J, Wissel J et al.
Correlation of clinical response in apo-morphine test with
D2-receptor status as demonstrated by
I123IBZM-SPECT.
Mov Disord.
1993;
8
453-458
-
11
Ward C D, Gibb W RG.
Research diagnostic criteria for Parkinson’s
disease.
Adv Neurol.
1990;
53
245-249
-
12
Hughes A J, Daniel S E, Kilford L et al.
Accuracy of clinical diagnosis of idiopathic
Parkinson’s disease: a clinicopathological study of 100 cases.
J Neurol Neurosurg Psychiatry.
1992;
55
181-184
-
13
Levitan I, Mangone C A, McKee A et al.
Natural history of progressive supranuclear palsy
(Steele-Richardson-Olszewski syndrome) and clinical predictors of survival: a
clinicopathological study.
J Neurol Neurosurg Psychiatry.
1996;
61
615-620
-
14
Wenning C, Tison F, Ben-Shlomo Y et al.
Multi system atrophy: a review of 203 pathologically proven
cases.
Mov Disord.
1997;
12
133-147
-
15
Hughes A J.
Apomorphine test in the assessment of parkinsonian patients:
a meta-analysis.
Adv Neurol.
1999;
80
363-368
-
16
Clarke C E, Davies P.
Systematic review of acute levodopa and apomorphine challenge
tests in the diagnosis of idiopathic Parkinson’s disease.
J Neurol Neurosurg Psychiatry.
2000;
69
590-594
-
17
Rossi P, Colosimo C, Moro E et al.
Acute challenge with apomorphin and levodopa in
parkinsonism.
Eur Neurol.
2000;
43
95-101
-
18
van Hilten J J, Wagemans E A, Ghafoerkhan S F et al.
Movement characteristics in Parkinson’s disease:
determination of dopaminergic responsiveness and threshold.
Clin Neuropharmacol.
1997;
20
402-408
-
19
Martinez-Martin P, Garcia Urra D, Balseiro Gomez J.
Timed tests in Parkinson’s disease evaluation.
Mov Disord.
1997;
12
127-128
-
20
Defer G L, Widner H, Marie R M et al.
Core assessment program for surgical interventional therapies
in Parkinson’s disease (CAPSIT-PD).
Mov Disord.
1999;
14
572-584
-
21
Goetz C G, Stebbins G T, Chumura T A et al.
Teaching tape for the motor section of the unified
Parkinson’s disease rating scale.
Mov Disord.
1995;
10
263-266
-
22
Hagell P.
Timed tests in clinical assessment of motor function in
Parkinson’s disease.
J Neurosci Nurs.
2000;
32
331-336
-
23
Jankovic J, Rajput A H, McDermott M P et al.
The evolution of diagnosis in early Parkinsons disease.
Parkinson Study Group.
Arch Neurol.
2000;
57
369-372
-
24
Linazasoro G.
The apomorphine test in Parkinson’s disease: diagnostic
value.
Neurologia.
1993;
8
288-290
-
25
Roth J, Ruzicka E, Mecir P.
The apomorphine test in the differential diagnosis of
parkinsonism.
Cas Lek Cesk.
1994;
133
665-667
-
26
Miranda M, Sacz D.
Apomorphine test: evaluation of dopaminergic response in
patients with Parkinson disease.
Rev Med Chil.
1995;
123
326-329
-
27
Zappia M, Montesanti R, Colao R et al.
Short-term levodopa test assessed by movement time accurately
predicts dopaminergic responsiveness in Parkinson’s disease.
Mov Disord.
1997;
12
103-106
-
28
Schwarz J, Tatsch K, Arnold G et al.
123I-iodobenzamide-SPECT in 83 patients with de
novo parkinsonism.
Neurology.
1993;
43
(S 06)
17-20
-
29
D’Costa D F, Sheehan L J, Phillips P A et al.
The levodopa test in Parkinson’s disease.
Age Ageing.
1995;
24
210-212
-
30
Fearnley J M, Lees A J.
Ageing and Parkinson’s disease: substantia nigra
regional selectivity.
Brain.
1991;
114
2283-2301
-
31
Gibb W R, Lees A J.
The significance of the Lewy body in the diagnosis of
idiopathic Parkinson’s disease.
Neuropathol Appl Neurobiol.
1989;
15
27-44
PD Dr. med. Karla Eggert
Neurologische Klinik, Philipps-Universität Marburg
Rudolf-Bultmann-Str. 8
35039 Marburg
Email: eggert@med.uni-marburg.de
