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Aktuelle Neurologie 2005; 32: 66-74
DOI: 10.1055/s-2004-834693
Übersicht
© Georg Thieme Verlag KG Stuttgart · New York

Apomorphintherapie bei idiopathischem Parkinson-Syndrom

Patientenprofil, Domperidoneinsatz, Pen versus Pumpe, Apomorphin vs. andere Therapien, praktische AnwendungApomorphine in Parkinson's DiseasePatient Selection, Domperidone Use, Pen versus Pump, Apomorphin versus other Modalities, Practical GuidelinesA.  Ceballos-Baumann1
  • 1Neurologisches Krankenhaus München, Zentrum für Parkinson und Bewegungsstörungen
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Publication History

Publication Date:
26 April 2005 (online)

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Zusammenfassung

Apomorphin stellt in vielen Ländern die Standardtherapie für schwer zu beeinflussende Off-Phasen bei idiopathischem Parkinson-Syndrom (IPS) dar. Diese Indikation beinhaltet auch mit Off-Phasen assoziierte Schmerzen, Panikattacken, Schluckstörungen sowie Blasenentleerungs- und Defäkationsstörungen. Doppelblinde Studien zeigen, dass die subkutane Verabreichung von 1 - 5 mg Apomorphin innerhalb von 10 Minuten eine motorische Besserung herbeiführen kann, die in ihrer Ausprägung vergleichbar oder deutlicher als mit L-Dopa ist und bis zu zwei Stunden anhält. Diese Übersicht dient der praktischen Information zu zwei Arten der subkutanen Apomorphinverabreichung: 1. dem Off-Symptom-orientierten Einsatz mittels Apomorphin-Pen von dem gelegentlichen Einsatz bis hin zu 10 Injektionen am Tag. 2. der kontinuierlichen subkutanen Dauerinfusion mittels einer tragbaren Minipumpe. Es werden behandelt: (i) Patientenselektion und -schulung, (ii) die Notwendigkeit der begleitenden Domperidonverabreichung zur Antiemesis, die viele Patienten nach kurzer Zeit nicht mehr benötigen, (iii) die Apomorphindosistitration, (iv) die Behandlung der unerwünschten Wirkungen und (v) Apomorphin versus andere Therapien (symptomorientierte L-Dopa-Darreichungen, tiefe Hirnstimulation, kontinuierliche duodenale L-Dopa-Infusion). Apomorphin sollte bei Patienten mit eindeutigem Ansprechen auf L-Dopa erwogen werden, die über eine unzuverlässige oder zu langsame Wirkung von zusätzlichen symptomorientierten L-Dopa-Dosen klagen.

Abstract

Apomorphine has become a standard rescue therapy for intractable „off” periods in Parkinson's disease (PD). This includes a variety of „off” phenomena, such as pain, panic attacks, and off period associated difficulties in swallowing, micturition and defaecation. Double-blind studies with subcutaneous injection doses of 1 to 5 mg have demonstrated that onset of clinical benefit typically occurs within 10 minutes, and lasts for up to two hours. The motor effect is similar in magnitude to that of levodopa (L-Dopa). This review provides practical information for application of apomorphine subcutaneous therapy in two modalities: 1. either as intermittent off-symptom orientated penject use analogous to rescue doses of levodopa or 2. as continuous subcutaneous infusion via a mini-pump. The publication addresses patient selection and education, the need for concomitant domperidone administration for antiemesis which for many patients wanes over time, apomorphine dosage titration and care of side-effect. Alternative treatments for apomorphine injectable such as sophisticated levodopa rescue dosing for the penject, and deep brain stimulation and continuous duodenal levodopa for the pump will be discussed. The use of apomorphine should be considered in patients with a clear cut response to levodopa who complain of unreliable or slow responses to additional rescue doses of levodopa in off-phases.

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Prof. Dr. Andres Ceballos-Baumann

Neurologisches Krankenhaus München · Zentrum für Parkinson und Bewegungsstörungen

Tristanstraße 20

80804 München

Email: andres.ceballos-baumann@nk-m.de

Email: a.ceballos@lrz.tum.de