Subcutaneous apomorphine in the treatment of progressive supranuclear palsy and corticobasal syndrome: A preliminary study of 7 cases

Abstract

Background: Treatment of tauopathies such as Progressive Supranuclear Palsy (PSP) and Corticobasal Degeneration (CBD) remains a major challenge. These neurodegenerative extrapyramidal movement disorders share phenotypic overlap and are usually painful. Continuous subcutaneous apomorphine infusion (CSAI) is commonly used in patients with advanced Parkinson's disease (PD) to alleviate motor and non-motor fluctuations.

Objective: We investigated the effects of CSAI especially on pain and, on quality of life in 7 patients with PSD or CBD.

Methods: This is an observational "real life" surveillance-based study. The patients received low dosages of subcutaneous apomorphine (2.24mg ± 0.8/h) in addition to their usual treatment. The Verbal Rating Scale for Pain (VRS) was used to assess changes in pain level and the clinical global impression-improvement scale (CGI-I) was used to assess changes in patient's illness during six months of treatment.

Results: All patients treated with apomorphine experienced an improvement of their well-being remaining stable across the study period with a CGI-I = 2.6 ± 0.5 and 2.6 ± 0.6 at 3 and 6 months, respectively. All patients experienced a significant pain reduction with a VRS = 7 ± 1 before pump, a VRS = 3.83 ± 1.83 the first month, a VRS = 3.16 ± 2.11 the third month and finally a VRS 4.2 ± 1.68 the sixth month (p = 0.0047, 0.0020 and 0.0121 respectively).

Conclusion: Our results suggest that use of subcutaneous apomorphine at low dose may be a valuable adjunct in the treatment of PSD and CBD for which only few symptomatic treatments are effective.

Keywords: Apomorphine; Corticobasal syndrome; Pain; Progressive supranuclear palsy.