Parkinson's disease infusion pump and apomorphine therapy

The disease takes its name from James Parkinson, a 19th century London surgeon, who was the first to outline its symptoms in his book entitled “A Treatise on Agitating Paralysis”.
Parkinson's disease can be described as the gradual but progressive degeneration of the nerve structures that constitute the extrapyramidal system.

The initial symptoms of Parkinson's disease manifest themselves after a considerable reduction in the production of dopamine, and the main motor disorders include: trembling at rest, stiffness, slowness of movement and difficulty of balance.

Parkinson's disease tends to mainly affect individuals over the age of fifty, though the causes are not yet completely understood.

Currently, there is no cure for Parkinson's disease, but treatments are available which can improve the quality of life of those affected.

Attack therapy for the treatment of Parkinson's disease is designed to replace dopamine via the oral administration of levodopa or dopamine agonists.

Although oral treatments for Parkinson's disease can substantially improve a patient's clinical condition over a period of several years, up to 80% develop motor response complications, often characterised by fluctuations such as an end-of-dose effect and dyskinesias.

Treatments are available for Parkinson's disease which aim to improve patients' quality of life.
Infusion pump therapy is one of them, administering a dopamine agonist called apomorphine under the skin.

Treatment with an infusion pump reduces tremor and the typical stiffness experienced by patients, allowing them to walk with greater control of movement.

Subcutaneous apomorphine administration, using appropriately programmed portable infusers, has been shown to be effective in controlling the disadvantages of pulsatile therapy and as such represents a particularly valid and useful therapeutic strategy.

All patients in the advanced stage of Parkinson's disease are potential candidates for treatment by means of an infusion pump with apomorphine, as this form of administration is the one that comes nearest to physiological dopaminergic stimulation.

To this end, CANÈ SpA has specifically designed and manufactured the Crono PAR portable infusion pump for subcutaneous apomorphine infusion.

Apomorphine is the oldest of the dopaminergic drugs, and was originally known for its anti-emetic characteristics.
The drug has been used to treat various medical conditions such as pain, insomnia, alcohol addiction and schizophrenia.

After initially being used subcutaneously in the treatment of Parkinson's disease, apomorphine was discarded for a number of years following the introduction of orally administered levodopa.
Apomorphine is the strongest of the dopamine agonists and can reduce symptoms to a similar extent to levodopa.

The drug's main characteistics are rapid absorption after subcutaneous injection and a short half-life (about 43 min.).
Effects can be detected after 5 to 15 minutes from subcutaneous administration, using either an injection pen or infusion pump.

Subcutaneous apomorphine administration, with a portable infusion pump, has proven to be effective in keeping the disease's complications under control.

It is crucial to select and manage patients who have to undergo such treatment, and they are usually sufferers with motor fluctuations and moderate to severe dyskinesia, conditions which cannot be helped by the use of standard treatments such as the redistribution of oral doses of levodopa, the addition of COMT inhibitors, amantadine, selegiline or oral dopaminergic agonists.

In these patients, apomorphine infusion pump therapy leads to a substantial reduction in the number of "off" hours and in involuntary movements.

Patients who have enjoyed a good “on” period during the initial phase of apomorphine treatment, but who need more than 10 infusion pen injections per day, may benefit from undertaking continuous infusion pump therapy.

Dosage will be established in function of the individual patient's needs, as portable infuser treatment must be customised according to the patient's daily apomorphine requirement.

The Crono Par infusion pump can autonomously administer a range of different pre-set flows during a 24-hour period, allowing the doctor to personalise Parkinson's disease treatment for each patient.

Treatment using the apomorphine infusion pump does not require surgical intervention, and as such it is one of the least invasive solutions available for treating the advanced stage of Parkinson's disease.

Given the small dimensions and lightness (127g) of the Crono PAR infusion pump, it is ideal for use in the home.
The infusion pump can be worn and attached to a fabric cord, or at the waist with the help of a case similar to those used for mobile phones, guaranteeing discretion during the course of the treatment.