To assess the antidyskinetic effect of continuous Subcutaneous Infusions of apomorphine administered during the day on parkinsonian fluctuations and L-DOPA Induced dyskinesias, twelve severely affected parkinsonian patients treated by continuous Subcutaneous Infusions of apomorphine (Britaject®, Britannia Pharmaceuticals Ltd., Redhill, U.K.) were examined over a period of one year. Four patients were men; eight patients were women. The mean age was 64.3 (SD = 9.2) years; the mean age at the onset of Parkinson's disease (PD) was 49.8 (SD = 7.7) years; the mean duration of the disease was 14.4 (SD = 6.3) years; the mean duration of L-DOPA treatment was 12.6 (SD = 5.4) years; the mean duration of motor fluctuations was 3.6 (SD = 1.8) years. In all the patients, the primary complications of long-term treatment were the fluctuations and L-DOPA Induced dyskinesias. The diagnosis of PD was established on the basis of UK-PDBB (United Kingdom Parkinson's Disease Brain Bank) criteria. Dyskinesias were assessed using the UPDRS (Unifled Parkinson's Disease Rating Scale) dyskinesia subscale and a patient questionnaire. Apomorphine was administered in the form of continuous Subcutaneous infusion by a portable infusion pump. The duration of the Infusions was 12 hours during the day. The L-DOPA and other dopaminergic treatment were reduced at different rates in the patients, but the patients always received a certain dole of L-DOPA. At the end of a one-year period, the mean total UPDRS, the mean UPDRS III motor subscore, and the UPDRS IV dyskinesia subscore were substantially reduced, and the off-phase duration was also substantially reduced during the day period. L-DOPA Induced dyskinesias, including peak-of-dose dyskinesias, biphasic dyskinesias, and off-period dyskinesias were noticeably suppressed. The end-of--dose dyskinesias disappeared completely. The total UPDRS value was decreased during the Infusions, but the parkinsonian symptomatology worsened in all patients during the night. No serious treatment complications were recorded. Sedation and sleepiness were relatively common, and occasionally present in all patients. Panniculitis and rashes at the injection sites were rare. The most probable explanation of the beneflcial effect of this type of combined treatment seems to be the synergic presynaptic as well as postsynaptic action of L-DOPA and apomorphine. The effect of indirect NMDA-receptor blockade should also be considered.

        Key words: Parkinson's disease, apomorphine, L-DOPA dyskinesias