Could apomorphine be an effective treatment option for refractory tremor in Parkinson's disease? A pilot study [Apomorfin parkinson hastaligindaki dirençli tremor için etkili bir tedavi seçenegi olabilir mi? Pilot çalişma]
Objective: We aimed to evaluate the extent of the clinical efficacy of intermittent subcutaneous apomorphine in addition to oral treatment in patients with Idiopathic Parkinson's Disease experiencing serious, refractory tremor despite the use of optimal oral dopaminergic medication. Treatment response was assessed with the motor section of the Unified Parkinson's Disease rating scale (UPDRS). Tremor, rigidity and bradykinesia were scored by using specific items of the UPDRS. Material and Method: The study group included 13 consecutive patients with Parkinson's disease who have refractory tremor. Increasing doses of 1 mg, 2 mg, 4 mg subcutaneous apomorphine were used; peak improvement dose and UPDRS scores were determined after 30 minutes. The patients have used oral dopaminergic treatment plus subcutaneous apomorhine and they have been followed on weekly phone calls. The completion of the study was defined as the end of the 1st month. Finally, the UPDRS motor scores of the patients were compared to the basal scores. Results: Three patients dropped out due to side effects. The average reduction rate of total UPDRS, tremor, bradykinesia and rigidity scores were found as 20.6%, 38.5%, 30.1% and 16.6% respectively. At the end of the first month, tremor, bradykinesia and rigidity scores were statistically improved in comparison to those of the baseline. Conclusion: Subcutaneous apomorphine combined to oral dopaminergic medications may provide effective relief in serious and refractory rest tremor as well as bradykinesia and rigidity in selected Parkinson patients.