Quantitative demonstration of the efficacy of night-time apomorphine infusion to treat nocturnal hypokinesia in Parkinson's disease using wearable sensors

• Published in: Parkinsonism & related disorders Vol. 33; pp. S36 - S41
• Main Authors: Bhidayasiri, Roongroj, Sringean, Jirada, Anan, Chanawat, Boonpang, Kamolwan, Thanawattano, Chusak, Ray Chaudhuri, K
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.12.2016
• Subjects: Aged; Apomorphine; Apomorphine - administration & dosage; Circadian Rhythm; Dopamine Agonists - administration & dosage; Female; Getting out of bed; Humans; Hypokinesia - drug therapy; Hypokinesia - etiology; Infusions, Subcutaneous - methods; Male; Middle Aged; Neurology; Nocturnal akinesia; Nocturnal hypokinesia; Parkinson Disease - complications; Parkinson's disease; Sensors; Severity of Illness Index; Treatment Outcome; Wearable Electronic Devices; Nocturnal hypokinesia; Nocturnal akinesia; Parkinson's disease; Sensors; Apomorphine; Getting out of bed
• DOI: 10.1016/j.parkreldis.2016.11.016
• ISSN: 1353-8020

Abstract Background Nocturnal hypokinesia/akinesia is one of the common night-time symptoms in patients with Parkinson's disease (PD), negatively affecting quality of life of patients and caregivers. The recognition of this problem and treatment options are limited in clinical practice. Objectives To evaluate the efficacy of nocturnal apomorphine infusion, using a wearable sensor, in patients who are already on daytime continuous subcutaneous apomorphine infusion and still suffer from nocturnal hypokinesia. Methods Nocturnal parameters in 10 PD patients before and during nocturnal infusion were assessed over two nights at their homes, using a wearable sensor (trunk). Nocturnal parameters included number, velocity, acceleration, degree, and duration of rolling over, and number of times they got out of bed. Correlations with validated clinical rating scales were performed. Results Following nocturnal apomorphine infusion (34.8 ± 6.5 mg per night), there were significant improvements in the number of turns in bed ( p  = 0.027), turning velocity ( p  = 0.046), and the degree of turning ( p  = 0.028) in PD patients. Significant improvements of Modified Parkinson's Disease Sleep Scale ( p  = 0.005), the axial score of Unified Parkinson's Disease Rating Scale ( p  = 0.013), and Nocturnal Akinesia Dystonia and Cramp Scale ( p  = 0.014) were also observed. Conclusion Our study was able to demonstrate quantitatively the efficacy of nocturnal apomorphine infusion in PD patients with nocturnal hypokinesia and demonstrated the feasibility of using wearable sensors to yield objective and quantifiable outcomes in a clinical trial setting. More studies are needed to determine the long-term efficacy of this treatment in a large prospective cohort of PD patients.