Continuous Subcutaneous Infusion Therapy with the Apomorphine Pump

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.