Indications

(sound reasons to use specific medication, procedures, tests or surgery) 

Summary

Indications for apomorphine injections:

• clinically relevant “off” periods in spite of optimised oral treatment.

Prerequisites:

• good levodopa and/or apomorphine responsiveness in “on” state
• patient or carer must understand the Parkinson’s symptoms and know when to administer the injection
• adequate training of patients and carers.

Indications for apomorphine infusion, levodopa/carbidopa infusion and DBS:

• advanced Parkinson’s with pronounced motor fluctuations and/or dyskinesias in spite of optmised peroral therapy
• disease sufficiently severe to warrant advanced treatment instead of oral/patch treatment
• special indication for pumps: nocturnal akinesia
• special indication for DBS: tremor that does not respond satisfactorily to pharmacological therapy.

Prerequisites:

• good levodopa or apomorphine response in “on” state
• adequate in-hospital training of patients and carers
• specialised nurses should ideally be available for training, consultation and general education of patients and carers.