Introduction
movement disorders, levodopa-treated, PD, Parkinson’s disease, dyskinesia, Manson et al., dyskinesias
MOVEMENT DISORDERS, DYSKINESIA
When motor fluctuations develop in levodopa-treated patients with Parkinson’s disease (PD), adjuvant medications, when used judiciously, can reduce fluctuations and dyskinesias and improve quality of life and activities of daily living (Chaudhuri et al. Subcutaneous apomorphine infusion has been used for over 30 years to maintain patients in the ON state while minimizing dyskinesia (Manson et al. According to the UK’s National Institute for Health and Care Excellence (NICE) guidelines, apomorphine should be considered as part of ‘best medical therapy’ before options that involve surgical interventions, such as deep brain stimulation (DBS) and gastro-jejunostomy used to deliver levodopa infusion (National Institute for Health and Care Excellence The efficacy and safety of apomorphine have been reported in many open-label and observational studies and confirmed in clinical practice (Jenner and Katzenschlager Despite its proven efficacy and safety, apomorphine infusion is still underused and often used too late to be optimally effective (Auffret et al. We aimed to address these concerns and to provide practical guidance for apomorphine infusion use, drawing on published evidence, the procedures in the TOLEDO study, and clinical experience from movement disorders specialists around the world.