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Frequently Asked Questions

What is Parkinson disease?

Parkinson disease (PD) is the second most common neurodegenerative disorder after Alzheimer’s disease. It is characterized by progressive loss of muscle control, due to loss of dopamine-producing brain cells. As symptoms worsen, it may become difficult to walk, talk, and do simple daily activities.

Still the causes of Parkinson’s remain unknown. Many experts think that the disease is caused by a combination of genetic and environmental factors. PD in industrialised countries is generally estimated at 0.3% of the entire population and about 1% in people over 60 years of age but early-onset Parkinson disease also occurs.

The progression of Parkinson disease and the degree of impairment vary from individual to individual. Many people with Parkinson disease live long lives without major progression, whereas others become disabled much more quickly.

What are the symptoms of Parkinson?

The primary symptoms of Parkinson disease are all related to voluntary and involuntary motor function and usually start on one side of the body. Symptoms are mild at first and will progress over time. Some individuals are more affected than others. Secondary symptoms vary in severity, and not every individual will experience all of them.

FOUR MAIN MOTOR SYMPTOMS OF PD

  • Shaking or tremor at rest.
  • Slowness of movement, called bradykinesia.
  • Stiffness or rigidity of the arms, legs or trunk.
  • Trouble with balance and falls, also called postural instability. Postural instability usually
    appears later with disease progression and may not be present with initial diagnosis.

SECONDARY SYMPTOMS OF PD MAY INCLUDE

  • Small, cramped handwriting, called micrographia.
  • Reduced arm swing on the affected side.
  • Slight foot drag on affected side creating a shuffled walk.
  • “Freezing”—a term used to describe the phenomenon of being “stuck in place” when attempting to walk.
  • Loss of facial expression due to rigidity of facial muscles, called hypomimia.
  • Low voice volume, called hypophonia.
  • Tendency to fall backwards, called retropulsion.
  • Decrease ability in automatic reflexes such as blinking and swallowing.

NON-MOTOR SYMPTOMS MAY INCLUDE

  • Mood (depression, anxiety, irritability)
  • Cognitive changes (attention, visuo-spatial problems, memory problems, personality changes, psychosis/hallucinations)
  • Lightheaded and low blood pressure upon standing
  • Feeling of fullness after eating small amounts
  • Excessive sweating, especially of hands and feet
  • Dry skin
  • Urinary urgency, frequency and incontinence
  • Loss of sense of smell
  • Sleep disorders
  • Sensory (pain, tightness, tingling, burning)

What is diagnosis of Parkinson?

Making an accurate diagnosis of Parkinson’s, especially in its early stages, is difficult. Usually the diagnosis of Parkinson’s is not made by a family physician. Affected patients seek an additional opinion from a neurologist with experience and specific training in the assessment and treatment of Parkinson’s disease. To diagnose Parkinson’s, the physician takes a careful neurological history and performs an examination. A reliable and easily applicable diagnostic test or marker for PD is not yet available. The diagnosis is based on the clinical information provided by the person with Parkinson’s and the findings of the neurological examination. In addition the best objective testing for PD consists of specialized brain scanning techniques that can measure the dopamine system and brain metabolism. The main role of additional testing is to exclude other diseases that have similar symptoms like Parkinson’s disease.

What are the stages of Parkinson?

The stages of Parkinson correspond to the severity of movement symptoms and how much a person’s daily activities are affected. The most commonly used rating scales are focused on the motor symptoms, but new scales include information on non-motor symptoms (such as cognitive problems or sense of smell).

The Hoehn and Yahr scale rates symptoms on a scale of 1 to 5. On this scale, depending on a person’s difficulties, 1 and 2 represent early-stage, 2 and 3 mid-stage, and 4 and 5 advanced-stage Parkinson.

Another scale commonly used to assess the progression of Parkinson is the United Parkinson’s Disease Rating Scale (UPDRS). It focuses on movement symptoms. In addition to these, the UPDRS takes into account cognitive difficulties, ability to carry out daily activities, and treatment complications.

MILD PARKINSON’S DISEASE

Movement symptoms may be inconvenient, but do not affect daily activities.

MODERATE PARKINSON’S DISEASE

Movement symptoms occur on both sides of the body and movements are more slowly. Trouble with balance and coordination may develop. Movements may become stuck ("freezing" episodes). Symptoms can reappear quickly and unexpectedly, which could be described as being like a light switch being turned on and off ("on/off" syndrome). Parkinson medications may "wear off" between doses.

ADVANCED PARKINSON’S DISEASE

This stage corresponds to great difficulty with the ability to get up or walk. The patients might not be able to live alone and assistance is needed with all daily activities. Cognitive problems may be prominent, including hallucinations and delusions.

The beneficial effects of oral medication becomes unpredictable and is failing to control motor fluctuations. Other therapy strategies such as continuous drug delivery or stimulation have to be considered.

What are the treatment options for Parkinson?

Whilst treatment is constantly improving, researchers have not yet been able to find a way to prevent or cure Parkinson. For all stages of Parkinson, the available therapies will help to ease symptoms which can be effectively controlled, often using a combination of the following:

  • medication
  • conventional therapies, such as physiotherapy, occupational therapy, speech and language therapy
  • complementary therapies, such as aromatherapy, reflexology, yoga and Tai Chi
  • surgical treatments

There is no single, optimal treatment because the condition affects each individual differently. You will need to work with your doctor to find the right balance of treatments for your specific symptoms. Regular reviews will be required and adjustments made as symptoms alter.

What is Apomoprhine?

Apomorphine hydrochloride (Dacepton®, Dopaceptin®) is injected into the area under the skin (subcutaneously). Apomorphine hydrochloride belongs to a group of medicines known as dopamine agonists and is used to treat Parkinson’s disease and helps to reduce the amount of time spent in an ‘off’ or immobile state in people who have previously been treated for Parkinson’s disease with levodopa (another treatment for Parkinson‘s disease) and/or other dopamine agonists. Your doctor or nurse will help you to recognise the signs of when to use your medicine. Despite the name, apomorphine does not contain morphine.

what is Apomorphine pen and pump therapy?

APOMORPHINE INTERMITTENT INJECTION

Despite optimization of oral medication apomorphine intermittent subcutaneous injection therapy is an option for quick relief from sudden ‘off’ periods or morning akinesia.

The amount of Dacepton® 10 mg/ml you should use and the number of injections required each day will depend upon your personal needs. Your doctor will discuss this with you and tell you how much of your medicine you should inject and how often. The amount that will work best for you will have been determined during your visit to the specialist clinic.

NEW AND REUSABEL D-mine® PEN INJECTOR

EVER Pharma developed the D-mine® pen injector especially for intermittent bolus injections with Apomorphine. This pen facilitates the handling of the injections and the sophisticated design of the device allows a discrete application.

Please find more information about the D-mine® pen injector in the download area

Set-up clip

Handling Video

APOMORPHINE PUMP THERAPY

Patients who have shown a good "on" period response during the initiation stage, but whose overall control remains unsatisfactory using intermittent injections, or who require many and frequent injections (more than 10 per day), may be commenced on or transferred to continuous subcutaneous infusion by minipump and/or syringe-driver. The choice of which minipump and/or syringe driver to use will be decided by your doctor.

WHAT DOES CONTINUOUS INFUSION MEAN

Oral treatments cause pulsatile stimulation and contribute to "peaks and troughs" in blood plasma levels because of the blood-brain barrier. Continuous infusion of medication is the most rapid and efficient way of delivering a drug and ensures constant and consistent control. Absorption issues seen with oral medication are avoided.

With a subcutaneous infusion apomorphine is administered constantly. The continuous dopaminergic stimulation (CDS) closely resembles the way the brain works, by providing continuous stimulation of receptors. The short and extremely fine needle of an infusion set is positioned into the subcutaneous fatty tissue of the belly just under the skin. The infusion set is connected with a small portable minipump and/or syringe-driver.

PUMP THERAPY

The pump system is easy to operate and set up, and you will be taught how to do this. For most patients, a full day’s treatment can be set up. This enables patients to set the pump up in the morning (or have it set up by a carer) just once a day. Patients may get on with their daily activities without living after strict timetables.

Examples

EVER Pharma developed the D-mine® pen injector especially for intermittent bolus injections with Apomorphine. This pen facilitates the handling of the injections and the sophisticated design of the device allows a discrete application.


Set-up clip