Department of Neurology, Movement Disorder Clinic, University Hospital of Bispebjerg, 2400, Copenhagen, Denmark.
Department of Neurology and Karl Landsteiner Institute for Neuroimmunological and Neurodegenerative Disorders, Klinik Donaustadt, Vienna, Austria.
J Neural Transm (Vienna). 2023 Nov;130(11):1475-1484. doi: 10.1007/s00702-023-02686-7. Epub 2023 Sep 1.
Subcutaneous apomorphine infusion is a device-aided therapy for Parkinson's disease that can be considered when motor fluctuations become persistent and are no longer adequately controlled by oral/transdermal medication. Apomorphine infusion is less invasive than enteral levodopa, deep brain stimulation or focused ultrasound, and is often indicated even when neurosurgical approaches are contraindicated. This article aims to provide practical guidance for doctors and nurses initiating and treating patients with apomorphine infusion, and is based on both trial data and clinical experience from movement disorders specialists. A post hoc analysis of data from the TOLEDO randomized clinical trial of apomorphine infusion was conducted along with an analysis of 'real world' experience from 13 movement disorders specialists using a questionnaire that focused on starting patients on apomorphine infusion. Practical guidelines for starting treatment with apomorphine infusion are provided taking into consideration the regional disparities in healthcare. Apomorphine infusion is straightforward to administer but to be successful it requires concordance from the patient and family, and clinical support from an experienced team of doctors and nurses, particularly in the early months of treatment.
皮下注射阿朴吗啡输注是一种辅助设备的帕金森病疗法，当运动波动变得持续且口服/透皮药物不再能充分控制时，可以考虑使用。与肠内左旋多巴、深部脑刺激或聚焦超声相比，阿朴吗啡输注的侵入性更小，即使神经外科方法被禁止，也通常适用。本文旨在为启动和治疗接受阿朴吗啡输注的患者的医生和护士提供实用指南，这基于试验数据和运动障碍专家的临床经验。对皮下注射阿朴吗啡输注的 TOLEDO 随机临床试验数据进行了事后分析，并对 13 位运动障碍专家使用的问卷进行了“真实世界”经验分析，该问卷侧重于启动阿朴吗啡输注治疗的患者。考虑到医疗保健方面的区域差异，提供了启动阿朴吗啡输注治疗的实用指南。皮下注射阿朴吗啡输注的操作简单，但要取得成功，需要患者和家属的配合，以及由经验丰富的医生和护士团队提供临床支持，尤其是在治疗的早期阶段。
