Terminal Care in Parkinson's Disease: Real-Life Use of Continuous Subcutaneous Apomorphine Infusion to Improve Patient Comfort.

Autor:	Béreau M; Neurology Department, CHU Besançon, Besançon, France.; Université de Franche-Comté, UR LINC, Besançon, France., Giffard M; Mobile Palliative Care Team, CHU Besançon, Besançon, France.; Inserm CIC 1431, CHU Besançon, Besançon, France., Clairet AL; Department of Pharmacy, University Hospital of Besançon, Besançon, France., Degenne G; Palliative care unit, Clinique des Augustines, Malestroit, France., Tatu L; Neurology Clinical Electrophysiology Department, CHU Besançon, Besançon, France.; Laboratoire d'Anatomie, Université de Franche-Comté, Besançon, France., Richfield E; North Bristol NHS Trust, Department of Geriatrics, Southmead Road, Southmead, Bristol, UK., Magnin E; Neurology Department, CHU Besançon, Besançon, France.; Université de Franche-Comté, UR LINC, Besançon, France.; Centre Neurodéveloppemental ⪡Hors Normes⪢, AFTC, Besançon, France., Vérin M; Institut des Neurosciences Cliniques de Rennes (INCR), Rennes, France.; Behavior & Basal Ganglia Research Unit, CIC-IT, CIC1414, Pontchaillou University Hospital, & University of Rennes, Rennes, France.; Neurology Department, Movement Disorders Unit, Pontchaillou University Hospital, Rennes, France., Auffret M; Institut des Neurosciences Cliniques de Rennes (INCR), Rennes, France.; Behavior & Basal Ganglia Research Unit, CIC-IT, CIC1414, Pontchaillou University Hospital, & University of Rennes, Rennes, France.; France Développement Electronique (FDE), Monswiller, France.
Jazyk:	angličtina
Zdroj:	Journal of Parkinson's disease [J Parkinsons Dis] 2024; Vol. 14 (1), pp. 209-219.
DOI:	10.3233/JPD-230201
Abstrakt:	Background: There are currently no recommendations on the therapeutic management of Parkinson's disease (PD) patients at the end of life. Objective: To describe a cohort of patients with PD who benefited from continuous subcutaneous apomorphine infusion (CSAI) initiation at the end of their life as comfort care. Methods: This real-life cohort includes 14 PD patients, who benefited from 24-h, low-dose CSAI (0.5-3 mg/h) in the context of terminal care. Patient's comfort (pain, rigidity, and/or ability to communicate) and occurrence of CSAI-related side-effects (nausea/vomiting, cutaneous and behavioral manifestations) were evaluated based on medical records. Results: All patients (age 62-94 years, disease duration 2-32 years) presented with late-stage PD and a compromised oral route. Treatment lasted from a few hours to 39 days. CSAI led to substantial functional improvement, with a good safety profile. Overall clinical comfort was deemed improved by the medical team, the patient, and/or caregivers. Conclusions: CSAI might be a promising approach in PD terminal care, as it reduces motor symptoms and overall discomfort, with an apparent good safety profile. Use of the apomorphine pen, sublingual film or a classic syringe pump might be considered when apomorphine pumps are not available. Larger observational cohorts and randomized controlled trials are needed to establish the efficacy and tolerability of apomorphine in the context of terminal care and more broadly, in an advance care planning perspective.
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu