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İleri Evre Parkinson Hastalığında Subkutan Apomorfin Klinik Deneyimlerimiz

Year 2018, Volume: 8 Issue: 2, 254 - 259, 29.06.2018
https://doi.org/10.31832/smj.424615

Abstract

Giriş:Parkinson
hastalığı bazal ganglionlardaki substansia nigranın pars kompaktasındaki
dopaminerjik nöron kaybı ile giden yaygın nörodejeneratif bir hastalıktır.
Parkinsondaki en etkili tedavi oral dopaminerjik ajanlardır. Ancak İleri Evre
Parkinson Hastalığı (İEPH)’ında oral dopaminerjik tedavi seçeneklerine klinik
yanıtın azalması
subkutan apomorfin tedavisine olan ilgiyi artırmıştır.
Bu çalışmada kliniğimizde İEPH’da 5 yıllık süre boyunca  subkutan apomorfin tedavisi uygulanan
hastaların verileri sunulmaktadır.



Materyal ve metod: Bu çalışmada kliniğimize
2012-2017 yılları arasında baş vuran,
UK Parkinson's
Disease Society Brain Bank tanı kriterlerine göre tanı konulan ve subkutan
apomorfin tedavisi alan 28
İEPH’nın
dosyaları retrospektif olarak incelendi. Hastaların demografik verileri,
hastalık başlama yaşı, hastalık süresi, uygulama öncesi Hoehn-Yahr
(H&Y) evresi, UPDRS motor skorları, günlük total off süreleri, diskinezi şiddeti, günlük kullanılan total levodopa
dozları, apomorfin dozu, kullanım süresi, kullanım şekli
kaydedildi. Daha sonra tedavi öncesi ve sonrası günlük total levodopa dozu, off
süreleri, diskinezi şiddeti, UPDRS motor skorları kaydedildi ve istatistiksel
olarak karşılaştırıldı.



Bulgular: Çalışmaya alınan hastaların
16’sı erkek, 12’si kadın cinsiyette idi. Ortalama hastalık başlama yaşı
63,4±4,9 hastalık süresi 10,1±2,8 yıl idi. Ortalama günlük total subkutan apomorfin
dozu 53,5±18,9 mg kullanım süresi 17,6±9 ay idi. Uygulama öncesi en iyi on
döneminde yapılan nörolojik muayenede ortalama off süresi 4,4±1,6 saat iken
uygulama sonrası ortalama off süresi 1,1±0,3 saat idi ve istatistiksel olarak anlamlı
fark saptandı(p<0,001). Uygulama öncesi ve sonrası en iyi on döneminde
yapılan muayenede ortalama diskinezi şiddeti, UPDRS motor skorları ve ortalama
levodopa dozlarında istatistiksel olarak anlamlı fark saptanmıştır.(sırasıyla p<0,001,
p<0,001, p<0,001)



Sonuç: Subkutan apomorfin
uygulaması
İEPH’da
UPDRS skorlarında, levodopa dozunun azaltılmasında, off sürelerinin
kısaltılmasında ve diskinezilerin azaltılmasında etkilidir. 

References

  • 1-Yiğit G, Arıcıoğlu F. Günümüz ve Gelecekte Parkinson Hastalığı için Farmakolojik Tedavi Yaklaşımları MÜSBED 2015;5(4):265-273 DOI: 10.5455/musbed.20150827011840
  • 2-Douglas MR. Gene therapy for Parkinson’s disease: state-of-the-art treatments for neurodegenerative disease. Expert Rev Neurother. 2013; 13(6): 695-705.
  • 3-Connolly BS, Lang AE. Pharmacological treatment of Parkinson disease: a review. JAMA. 2014; 311(16): 1670-83. 6. ////Pahwa R, Lyons KE. Treatment of early Parkinson’s disease. Curr Opin Neurol. 2014; 27(4): 442-9.
  • 4-Menon R, Stacy M. Apomorphine in the treatment of Parkinson's disease. Expert Opin Pharmacother. 2007 Aug;8(12):1941-50
  • 5-Dewey RB Jr 10 questions about using apomorphine for Parkinson disease. Neurologist. 2005 May;11(3):190-2. DOI:10.1097/01.nrl.0000159988.88538.74
  • 6-Bhidayasiri R, Chaudhuri K.R, LeWitt P, Martin A, Boonpang K, et al. Effective Delivery of Apomorphine in the Management of Parkinson Disease: Practical Considerations for Clinicians and Parkinson Nurses Clin Neuropharm 2015;38: 89–103.
  • 7--Chen JJ, Obering C.. A review of intermittent subcutaneous apomorphine injections for the rescue management of motor fluctuations associated with advanced Parkinson's disease. Clin Ther. 2005 Nov;27(11):1710-24.)
  • 8-Efficacy and Safety of APL-130277 in People with Parkinson’s Disease who are Apomorphine Naïve. (2014). Erişim: 30 Ocak 2015, https:// www.michaeljfox.org/ foundation/grant-detail.php?grant_id=1343.
  • 9- Ossig C. Reichmann H. Treatment of Parkinson’s disease in the advanced stage Neural Transm (2013) 120:523–529 DOI 10.1007/s00702-013-1008-y.
  • 10-García Ruiz PJ et al. Efficacy of long-term continuous subcutaneous apomorphine infusion in advanced Parkinson's disease with motor fluctuations: a multicenter study. Mov Disord. 2008 Jun 15;23(8):1130-6. doi: 10.1002/mds.22063. PubMed PMID:18442107.
  • 11-Katzenschlager R, Hughes A, Evans A, et al. Continuous subcutaneous apomorphine therapy improves dyskinesias in Parkinson’s disease: a prospective study using single-dose challenges. Mov Disord 2005;20:151–157
  • 12- Morgante L, Basile G, Epifanio A, et al. Continuous apomorphineinfusion (CAI) and neuropsychiatric disorders in patients with advanced Parkinson’s disease: a follow-up of two years. Arch Gerontol Geriatr Suppl 2004;9:291–296.
  • 13-De Gaspari D, Siri C, Landi A, et al. Clinical and neuropsychological follow up at 12 months in patients with complicated Parkinson’s disease treated with subcutaneous apomorphine infusion or deep brain stimulation of the subthalamic nucleus. J Neurol Neurosurg Psychiatry 2006;77:450–453.
  • 14-Borgemeester RWK, van Laar T. Continuous subcutaneous apomorphine infusion in Parkinson's disease patients with cognitive dysfunction: A retrospective long-term follow-up study. Parkinsonism Relat Disord.2017 Dec;45:33-38.doi:10.1016/j.parkreldis.2017.09.025.Epub 2017 Sep29
  • 15- Sesar Á, Fernández-Pajarín G, Ares B, Rivas MT, Castro A. Continuous subcutaneous apomorphine infusion in advanced Parkinson's disease: 10-year experience with 230 patients. J Neurol. 2017 May;264(5):946-954. doi: 10.1007/s00415-017-8477-0. Epub 2017 Mar 31.
  • 16-Pfeiffer RF. Gutmann L. Hull KL. Bottini B.P. Sherry J.H. The APO302 study İnvestigators. Continued efficacy and safety of subcutaneous apomorphine in patients with advanced Parkinson’s disease. Parkinsonism and Related Disorders 13 (2007) 93–100
Year 2018, Volume: 8 Issue: 2, 254 - 259, 29.06.2018
https://doi.org/10.31832/smj.424615

Abstract

References

  • 1-Yiğit G, Arıcıoğlu F. Günümüz ve Gelecekte Parkinson Hastalığı için Farmakolojik Tedavi Yaklaşımları MÜSBED 2015;5(4):265-273 DOI: 10.5455/musbed.20150827011840
  • 2-Douglas MR. Gene therapy for Parkinson’s disease: state-of-the-art treatments for neurodegenerative disease. Expert Rev Neurother. 2013; 13(6): 695-705.
  • 3-Connolly BS, Lang AE. Pharmacological treatment of Parkinson disease: a review. JAMA. 2014; 311(16): 1670-83. 6. ////Pahwa R, Lyons KE. Treatment of early Parkinson’s disease. Curr Opin Neurol. 2014; 27(4): 442-9.
  • 4-Menon R, Stacy M. Apomorphine in the treatment of Parkinson's disease. Expert Opin Pharmacother. 2007 Aug;8(12):1941-50
  • 5-Dewey RB Jr 10 questions about using apomorphine for Parkinson disease. Neurologist. 2005 May;11(3):190-2. DOI:10.1097/01.nrl.0000159988.88538.74
  • 6-Bhidayasiri R, Chaudhuri K.R, LeWitt P, Martin A, Boonpang K, et al. Effective Delivery of Apomorphine in the Management of Parkinson Disease: Practical Considerations for Clinicians and Parkinson Nurses Clin Neuropharm 2015;38: 89–103.
  • 7--Chen JJ, Obering C.. A review of intermittent subcutaneous apomorphine injections for the rescue management of motor fluctuations associated with advanced Parkinson's disease. Clin Ther. 2005 Nov;27(11):1710-24.)
  • 8-Efficacy and Safety of APL-130277 in People with Parkinson’s Disease who are Apomorphine Naïve. (2014). Erişim: 30 Ocak 2015, https:// www.michaeljfox.org/ foundation/grant-detail.php?grant_id=1343.
  • 9- Ossig C. Reichmann H. Treatment of Parkinson’s disease in the advanced stage Neural Transm (2013) 120:523–529 DOI 10.1007/s00702-013-1008-y.
  • 10-García Ruiz PJ et al. Efficacy of long-term continuous subcutaneous apomorphine infusion in advanced Parkinson's disease with motor fluctuations: a multicenter study. Mov Disord. 2008 Jun 15;23(8):1130-6. doi: 10.1002/mds.22063. PubMed PMID:18442107.
  • 11-Katzenschlager R, Hughes A, Evans A, et al. Continuous subcutaneous apomorphine therapy improves dyskinesias in Parkinson’s disease: a prospective study using single-dose challenges. Mov Disord 2005;20:151–157
  • 12- Morgante L, Basile G, Epifanio A, et al. Continuous apomorphineinfusion (CAI) and neuropsychiatric disorders in patients with advanced Parkinson’s disease: a follow-up of two years. Arch Gerontol Geriatr Suppl 2004;9:291–296.
  • 13-De Gaspari D, Siri C, Landi A, et al. Clinical and neuropsychological follow up at 12 months in patients with complicated Parkinson’s disease treated with subcutaneous apomorphine infusion or deep brain stimulation of the subthalamic nucleus. J Neurol Neurosurg Psychiatry 2006;77:450–453.
  • 14-Borgemeester RWK, van Laar T. Continuous subcutaneous apomorphine infusion in Parkinson's disease patients with cognitive dysfunction: A retrospective long-term follow-up study. Parkinsonism Relat Disord.2017 Dec;45:33-38.doi:10.1016/j.parkreldis.2017.09.025.Epub 2017 Sep29
  • 15- Sesar Á, Fernández-Pajarín G, Ares B, Rivas MT, Castro A. Continuous subcutaneous apomorphine infusion in advanced Parkinson's disease: 10-year experience with 230 patients. J Neurol. 2017 May;264(5):946-954. doi: 10.1007/s00415-017-8477-0. Epub 2017 Mar 31.
  • 16-Pfeiffer RF. Gutmann L. Hull KL. Bottini B.P. Sherry J.H. The APO302 study İnvestigators. Continued efficacy and safety of subcutaneous apomorphine in patients with advanced Parkinson’s disease. Parkinsonism and Related Disorders 13 (2007) 93–100
There are 16 citations in total.

Details

Primary Language Turkish
Subjects Health Care Administration
Journal Section Articles
Authors

Yeşim Güzey Aras 0000-0002-2000-8056

Türkan Acar 0000-0003-2001-914X

Publication Date June 29, 2018
Submission Date May 17, 2018
Published in Issue Year 2018 Volume: 8 Issue: 2

Cite

AMA Güzey Aras Y, Acar T. İleri Evre Parkinson Hastalığında Subkutan Apomorfin Klinik Deneyimlerimiz. Sakarya Tıp Dergisi. June 2018;8(2):254-259. doi:10.31832/smj.424615

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