What is apomorphine pump treatment – and how might it support people with Parkinson’s? Denmark-based neurologist Dr Tove Henriksen shares her experience working with the technology to improve care options for those living with the condition

Neurologist Dr Tove Henriksen became involved in the Parkinson’s community “by chance” and has now been researching ‘advanced’ Parkinson’s for 25 years.

Her team at Bispebjerg Hospital in Copenhagen, Denmark, spend their time working to develop and implement treatment options for those at later stages of the condition, such as deep brain stimulation (DBS) and non-oral medications. Among these is apomorphine, a type of dopamine agonist that takes liquid form.

“Dopamine agonists work by stimulating dopamine receptors on the nerves’ postsynaptic receptors, which detect and respond to different chemicals,” says Dr Henriksen. “They can be used to treat bradykinesia (slowness of movement), rigidity and tremor,” along with non-motor symptoms such as mood problems and apathy. “However, if taken orally, high doses of apomorphine are needed to have an effect in the brain.”

To counter this, Dr Henriksen’s team uses a small, battery-powered syringe pump to administer the liquid medicine directly into the tissue underneath the skin. The pump delivers the medicine via an attached infusion set. This provides a consistent flow of apomorphine, enabling people with Parkinson’s to be “stimulated continuously”.

“That way, we can use very small doses of apomorphine and the effect will kick in quite quickly,” says Dr Henriksen.

Dr Henriksen explains that different types of apomorphine pumps can be used depending on the person, but some are more commonly chosen: “The pumps we prefer are those that have a mixture of older and more modern technology,” explains Dr Henriksen. “Many of our older patients prefer traditional technology. I think it’s an advantage that people can feel the buttons, so it’s not like a smartphone.”

Because apomorphine is often used at more ‘advanced’ stages of the condition, when oral medication is not as effective, older people are the more likely candidates. “The people we consider for this treatment would usually be the same people we consider for deep brain stimulation,” explains Dr Henriksen. “But we’re hesitant to offer the surgery to those who are over the age of 70, for a number of reasons. These people can therefore be good candidates for apomorphine pump treatment.”

The liquid dopamine agonist may also help to supplement treatment for people who “experience erratic ‘off’ periods, who need to have an effect within a very short period of time”, says Dr Henriksen. “When apomorphine is administered subcutaneously (under the skin), the effect usually kicks in within five to 10 minutes. That can be a huge advantage. You can start with a dose in the morning to kick-start the effects and give extra doses throughout the day, and you can set the pump for a continuous flow.” The individual treatment setup must be agreed with one’s healthcare professional.

Although people who experience certain symptoms related to Parkinson’s, such as severe dementia, might not be eligible for the treatment, Dr Henriksen says: “A huge number of people with ‘advanced’ Parkinson’s are good candidates for apomorphine pump treatment.”

An illustration of an apomorphine pump.

Using the pump does require a level of management, says Dr Henriksen. “We need the person receiving treatment to take care of the pump. If someone is not able to do that, then we need a home nurse or carer to help.”

Her team informs those considering the pump about the effort required. “This treatment involves carrying a pump,” she says, “and also scheduling numerous outpatient appointments, to ensure it is working properly.”

There are also factors to consider when choosing the type of infusion set, including set material, needle length and insertion angle. For example, Dr Henriksen explains that an infusion set which uses a soft Teflon catheter and a device “that places the needle into the skin” can help to reduce the dexterity required to manage the insertion.

The infusion site, or place of insertion, may also vary based on a person’s needs. “We start out with the abdominal skin, where subcutaneous fat and good blood circulation reduce the risk of formation of noduli – that is, small knots in the skin,” says Dr Henriksen. “But in some cases, we use the top of the back and the upper part of the arms. This can require someone to help place the needle.”

With the needle inserted into the tissue, there is a risk of problems with the skin, such as swelling, formation of noduli or infection. “To avoid skin problems, we encourage people to rotate the infusion site,” says Dr Henriksen, “so the same place isn’t used again for a while.”

Because the pump is small and portable, it can provide a continuous flow throughout the day. “And this flow is very individual,” she adds.

Dr Henriksen’s advice for those interested in apomorphine pump treatment is to discuss their options with their healthcare professional. “We encourage people to talk to their local Parkinson’s association,” she says, explaining that in her home country of Denmark, people who have undergone deep brain stimulation surgery, levodopa and apomorphine treatment “volunteer to talk to others who could be interested in knowing more”.

Meanwhile, her team works to inform people with the condition and their carers about the “specialised Parkinson’s nurses connected to our clinic, some of whom are dedicated to apomorphine pump treatment”. She adds: “We also do a lot to make sure that the person is seen by the same neurologists and nurses every time.”

The key is to ensure people are comfortable and supported in the clinical setting and beyond, says Dr Henriksen. “I think it’s of paramount importance that people with Parkinson’s are happy with their treatment. We do what we can to make sure that they feel safe.”

Dr Tove Henriksen is a neurologist based at Bispebjerg Hospital in Copenhagen, Denmark. She has worked with people with Parkinson’s, treating neurological conditions and movement disorders, for more than 25 years. She is committed to ensuring people with Parkinson’s “feel safe” in her care.

For more information about dopamine agonists, including apomorphine, visit the Parkinson’s Europe website.

This article is sponsored by Convatec and Tove Henriksen has been paid by Convatec to provide information for this article. The information in this article is given for information purposes only and is not a substitute for advice from your doctor, pharmacist or other healthcare professional. Opinions expressed within this article are those of the individuals and not necessarily representative of Convatec.

The information does not represent an endorsement by Parkinson’s Europe of any particular treatments, products or companies. Parkinson’s Life makes no representations or warranties of any kind, express or implied, about the completeness or accuracy of information provided.

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