Pessoa Renata Ramina, Moro Adriana, Munhoz Renato Puppi, Teive Hélio A G, Lees Andrew J
Associação Paranaense de Portadores de Parkinsonismo, Curitiba PR, Brasil.
Faculdades Pequeno Príncipe, Departamento de Medicina, Curitiba PR, Brasil.
Arq Neuropsiquiatr. 2018 Dec;76(12):840-848. doi: 10.1590/0004-282X20180140.
Optimizing idiopathic Parkinson's disease treatment is a challenging, multifaceted and continuous process with direct impact on patients' quality of life. The basic tenet of this task entails tailored therapy, allowing for optimal motor function with the fewest adverse effects. Apomorphine, a dopamine agonist used as rescue therapy for patients with motor fluctuations, with potential positive effects on nonmotor symptoms, is the only antiparkinsonian agent whose capacity to control motor symptoms is comparable to that of levodopa. Subcutaneous administration, either as an intermittent injection or as continuous infusion, appears to be the most effective and tolerable route. This review summarizes the historical background, structure, mechanism of action, indications, contraindications and side effects, compares apomorphine infusion therapy with other treatments, such as oral therapy, deep brain stimulation and continuous enteral infusion of levodopa/carbidopa gel, and gives practical instructions on how to initiate treatment.
优化特发性帕金森病的治疗是一个具有挑战性、多方面且持续的过程，直接影响患者的生活质量。这项任务的基本原则是量身定制治疗方案，以最少的不良反应实现最佳运动功能。阿扑吗啡是一种多巴胺激动剂，用作治疗运动波动患者的急救疗法，对非运动症状可能有积极影响，是唯一一种控制运动症状能力与左旋多巴相当的抗帕金森病药物。皮下给药，无论是间歇性注射还是持续输注，似乎都是最有效且耐受性良好的途径。本综述总结了阿扑吗啡的历史背景、结构、作用机制、适应症、禁忌症和副作用，将阿扑吗啡输注疗法与其他治疗方法（如口服疗法、深部脑刺激和左旋多巴/卡比多巴凝胶持续肠内输注）进行了比较，并给出了关于如何开始治疗的实用指导。
