Apomorphine
- PDF / 170,523 Bytes
- 1 Pages / 595.245 x 841.846 pts (A4) Page_size
- 5 Downloads / 159 Views
1 S
Apomorphine withdrawal syndrome: case report A 68-year-old man developed apomorphine withdrawal syndrome following discontinuation of apomorphine. The man was diagnosed with Parkinson’s disease at the age of 49 years. In recent years, he presented with severe dyskinesias and motor fluctuations. He denied to undergo bilateral sub-thalamic nucleus (STN) deep brain stimulation (DBS). Therefore, he started treatment with SC apomorphine infusion [initial infusion rate not stated] for Parkinson’s Disease. The treatment with apomorphine was maintained for the next 14 months with positive response. At the age of 68 years, he consented for STN-DBS surgery. He was thus admitted for the STN-DBS surgery. Pre-operatively, he received a 24-hour continuous SC apomorphine infusion at a rate of 8.5 mg/h for 16 h of the day, followed by at a rate of 5.5 mg/h for the remaining 8 h of the day, along with concomitant levodopa/ carbidopa. Apomorphine infusion was suspended at the beginning of the procedure. During the STN-DBS surgery, after the second lead was placed, he exhibited lethargy, with mild hypertension and bradycardia of 40 beats per minute (bpm). The man was therefore treated with atropine. He showed a partial recovery; but, still exhibited somnolence. The surgery was thus resumed by putting him under unspecified general anaesthesia. One hour after the surgery, apomorphine was reintroduced at an infusion rate of 2 mg/h. Post-operative CT-scan revealed correct lead positioning and no complications. He showed remarkable improvement after the surgery, and apomorphine dosage was progressively reduced while increasing DBS stimulation amplitude. On post-operative day 8, apomorphine was stopped. Within five hours of apomorphine withdrawal, he exhibited a sudden lethargic state, not arousable by vocal or tactile stimuli (consciousness decreased). He also exhibited bradycardia of 40 bpm. A repeat head CT-scan was unremarkable. ECG, blood tests and cardiac enzymes were also normal. It was later determined that, these symptoms (lethargy, bradycardia, somnolence, hypertension etc) occurred following discontinuation of apomorphine, consistent with apomorphine withdrawal syndrome. Therefore, apomorphine was restarted at 3.5 mg/h. Within approximately 30 minutes, his alertness recovered completely and heart rate also normalised. Later, the infusion rate of apomorphine was reduced gradually and completely stopped. Two weeks later, no symptom of the withdrawal syndrome was evident. Oliveira V, et al. Loss of Awareness after Continuous Apomorphine Infusion Withdrawal in Parkinson’s Disease. Canadian Journal of Neurological Sciences 47: 576-577, No. 803501156 4, Jul 2020. Available from: URL: http://doi.org/10.1017/cjn.2020.43
0114-9954/20/1821-0001/$14.95 Adis © 2020 Springer Nature Switzerland AG. All rights reserved
Reactions 12 Sep 2020 No. 1821
Data Loading...
