{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T09:50:27Z","timestamp":1790243427084,"version":"4.1.0"},"reference-count":50,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2002,7,23]],"date-time":"2002-07-23T00:00:00Z","timestamp":1027382400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Movement Disorders"],"published-print":{"date-parts":[[2002,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Continuous subcutaneous infusion of apomorphine is now increasingly recognized as an effective treatment for refractory <jats:italic>off<\/jats:italic> periods and peak\u2010dose dyskinesias in Parkinson's disease. We have reviewed our experience with apomorphine infusions, after a strategy decision in 1995 based on emerging preclinical data, to treat all patients with steady\u2010state plasma levels of apomorphine throughout the waking day, minimizing additional pulsatile stimulation either by oral dopaminergic medication or bolus parenteral injections of apomorphine. Sixty\u2010four patients have been treated with apomorphine pumps and 45 of these successfully converted to monotherapy, managing to discontinue all other forms of dopaminergic stimulation during the daytime treatment period with apomorphine. Patients were followed up for a mean of 33.8 months (range, 4\u2013108 months) and clinical data analyzed retrospectively. The mean maintenance dose of apomorphine was 98 mg per 24 hours (monotherapy group: 103 mg\/24 hours; polytherapy group: 93 mg\/24 hours), which did not significantly increase at final follow\u2010up. There was a mean maximum dyskinesia reduction of 64% (S.D. = 20) in the monotherapy group, compared to 30% (S.D. = 33) in those continuing on polytherapy (<jats:italic>P<\/jats:italic> &lt; 0.001), despite a maintained increase in <jats:italic>on<\/jats:italic> time (monotherapy group: 55%, <jats:italic>P<\/jats:italic> &lt; 0.005; polytherapy group: 50%, <jats:italic>P<\/jats:italic> = 0.05). Fifteen patients failed to successfully convert to monotherapy but benefited nonetheless, and only 3 failed apomorphine infusional therapy altogether. Reasons for failure were mixed, including difficulty with compliance and adverse effects such as daytime somnolence, skin complications, and painful dystonias. There was a significantly higher success rate in patients able to manage the treatment either independently or with the help of their caregiver. These results confirm that subcutaneous apomorphine monotherapy can reset peak\u2010dose dyskinesia threshold in levodopa\u2010treated patients and further reduce <jats:italic>off<\/jats:italic>\u2010period disability after all available forms of oral medication, including long\u2010acting dopamine agonists, have been tried. \u00a9 2002 Movement Disorder Society<\/jats:p>","DOI":"10.1002\/mds.10281","type":"journal-article","created":{"date-parts":[[2002,12,4]],"date-time":"2002-12-04T09:20:29Z","timestamp":1038993629000},"page":"1235-1241","source":"Crossref","is-referenced-by-count":180,"title":["Apomorphine monotherapy in the treatment of refractory motor complications of Parkinson's disease: Long\u2010term follow\u2010up study of 64 patients"],"prefix":"10.1002","volume":"17","author":[{"given":"Alice J.","family":"Manson","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kirsten","family":"Turner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew J.","family":"Lees","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2002,7,23]]},"reference":[{"key":"e_1_2_6_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(76)91416-1"},{"key":"e_1_2_6_3_2","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.40.2.340"},{"key":"e_1_2_6_4_2","doi-asserted-by":"publisher","DOI":"10.1093\/brain\/123.11.2297"},{"key":"e_1_2_6_5_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM200103083441002"},{"key":"e_1_2_6_6_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.316.7140.1259"},{"key":"e_1_2_6_7_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-0404.1998.tb05955.x"},{"key":"e_1_2_6_8_2","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.50.5.1323"},{"key":"e_1_2_6_9_2","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.48.3.658"},{"key":"e_1_2_6_10_2","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.55.6.795"},{"key":"e_1_2_6_11_2","doi-asserted-by":"publisher","DOI":"10.1097\/00002826-199704000-00001"},{"key":"e_1_2_6_12_2","doi-asserted-by":"publisher","DOI":"10.1097\/00002826-199406000-00004"},{"key":"e_1_2_6_13_2","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp.65.5.709"},{"key":"e_1_2_6_14_2","first-page":"545","article-title":"Effects of long\u2010term, continuous subcutaneous apomorphine infusions on motor complications in advanced Parkinson's disease","volume":"80","author":"Wenning GK","year":"1999","journal-title":"Adv Neurol"},{"key":"e_1_2_6_15_2","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp.53.2.96"},{"key":"e_1_2_6_16_2","doi-asserted-by":"publisher","DOI":"10.1002\/mds.870080208"},{"key":"e_1_2_6_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(88)90860-4"},{"key":"e_1_2_6_18_2","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp.64.5.573"},{"key":"e_1_2_6_19_2","doi-asserted-by":"publisher","DOI":"10.1002\/mds.1276"},{"key":"e_1_2_6_20_2","first-page":"280","article-title":"Parkinson Psychosis Rating Scale: a practical instrument for grading psychosis in Parkinson's disease","volume":"21","author":"Friedberg G","year":"1998","journal-title":"Clin Neuropharmacol"},{"key":"e_1_2_6_21_2","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp.68.4.423"},{"key":"e_1_2_6_22_2","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2133.1998.02128.x"},{"key":"e_1_2_6_23_2","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.52.9.1908"},{"key":"e_1_2_6_24_2","doi-asserted-by":"publisher","DOI":"10.2165\/00003495-199855001-00001"},{"issue":"1","key":"e_1_2_6_25_2","first-page":"23","article-title":"The rationale for continuous dopaminergic stimulation in patients with Parkinson's disease","volume":"42","author":"Sage JI","year":"1992","journal-title":"Neurology"},{"key":"e_1_2_6_26_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1471-1931(00)00029-X"},{"key":"e_1_2_6_27_2","doi-asserted-by":"publisher","DOI":"10.1002\/ana.410420508"},{"key":"e_1_2_6_28_2","doi-asserted-by":"publisher","DOI":"10.1002\/mds.870130603"},{"key":"e_1_2_6_29_2","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.39.7.888"},{"key":"e_1_2_6_30_2","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp.44.11.1020"},{"key":"e_1_2_6_31_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM200005183422004"},{"key":"e_1_2_6_32_2","doi-asserted-by":"crossref","first-page":"275","DOI":"10.1016\/S0022-3565(25)39350-X","article-title":"Differential effect of selective D\u20101 and D\u20102 dopamine receptor agonists on levodopa\u2010induced dyskinesia in 1\u2010methyl\u20104\u2010phenyl\u20101,2,3,6\u2010tetrahydropyridine\u2010exposed monkeys","volume":"267","author":"Blanchet P","year":"1993","journal-title":"J Pharmacol Exp Ther"},{"key":"e_1_2_6_33_2","doi-asserted-by":"crossref","first-page":"134","DOI":"10.1017\/S0317167100041500","article-title":"Levodopa\u2010induced dyskinesia: facts and fancy. 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