Kontinuierliche Therapie mit der Apomorphinpumpe

Zusammenfassung

Die kontinuierliche subkutane Infusion mit Apomorphin gehört neben der duodenalen Infusion von L-Dopa via PEG (perkutane enterale Gastrostomie) und der tiefen Hirnstimulation mit intrazerebralen Elektroden zu den 3 ressourcenintensiveren Therapien der Parkinsonkrankheit. Von diesen Therapien ist die Apomorphinpumpe für den Patienten die am schnellsten und einfachsten „ausprobierbare” Therapie, weil sie keinen operativen Eingriff wie den einer PEG oder Hirnoperation erfordert. Die kontinuierliche subkutane Infusion mit Apomorphin kann Off-Zeiten um mehr als 50 % (bis zu 85 %) reduzieren. Außerdem werden bestehende L-Dopa-induzierte Dyskinesien längerfristig signifikant gelindert. Es finden sich Verlaufsbeobachtungen von über 100 Monaten mit nachhaltiger Wirksamkeit. Hauptproblem der kontinuierlichen subkutanen Infusion sind die Hauterscheinungen an den Injektionsstellen, während unerwünschte psychiatrische Probleme eine geringe Rolle spielen. In anderen europäischen Ländern ist die Therapie mit der Apomorphinpumpe viel weiter verbreitet als in Deutschland. Ziel dieses Artikels ist es, Indikationen, praktisches Vorgehen sowie den Umgang mit Problemen der kontinuierlichen subkutanen Apomorphintherapie vorzustellen.

Abstract

The continuous subcutaneous infusion of apomorphine represents together with the duodenal infusion of levodopa via percutaneous gastrostomy and deep brain stimulation one of the three resource dependent therapeutic interventions in Parkinson’s disease. Among these therapeutic options the apomorphine pump is the treatment which is most easily and readily tested, because it does not need any surgical procedure. The continuous subcutaneous infusion of apomorphine can reduce Off-time by more than 50 % (up to 85 %) and lessen preexisting levodopa dyskinesias significantly. There are reports with a mean follow up of up to more than 100 months. The main side effects of subcutaneous apomorphine treatment are cutaneous nodules, whereas sedation and psychiatric complications play a lesser role. In other European countries the use of the apomorphine pump is by far more extended than in Germany. The aim of this article is to present the indications, practical issues and handling of problems with subcutaneous apomorphine treatment.

Schlüsselwörter

Parkinsonsyndrom - Medikamentenpumpen - Apomorphin - Dopaminagonisten - Dopa

Keywords

Parkinson disease - medication pumps - apomorphine - dopamine agonists - levodopa, L-dopa

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