Each one of us has his/her horror symptom. Mine is antecollis. And I am sure I am not alone. For that reason, I want to know how it comes about and what I can do about it.
Antecollis is the term used to describe excessive forward flexion of the neck (more than 45°). It is one of the dystonias and is often accompanied by neck pain and difficulty swallowing.
Antecollis often does not respond to medical therapies, is also often recalcitrant to drug therapy and to botulinum toxin (Botox) therapy. Apomorphine is said to be promising, but what is it actually?
Apomorphine, a potent dopamine agonist that acts on two dopamine receptors (D1 as well as D2), has been used with some success in Parkinson’s disease, particularly in patients with severe long-term side effects of levodopa. Because of metabolization in the liver, it must be administered subcutaneously, sublingually, or intranasally. Its adverse effects are similar to those of levodopa. Yawning, drowsiness, nausea, and vomiting may result from apomorphine use.
Local reactions to subcutaneous infusion of apomorphine in the nose and throat include swelling of the nose and lips, inflammation of the oral mucosa, and damage to the buccal mucosa. Skin lesions cause major problems in about 10% of patients after 3 or more years. One solution may be intravenous application of the drug through an indwelling cannula. In one study, such cannulas were inserted in six patients who had responded well to subcutaneous apomorphine before nodules developed. Intravenous therapy reduced the dosage of oral antiparkinsonian drugs by 59% and resulted in a significant reduction in dyskinesias and improved quality of life. However, there were also major problems. Two patients who received high doses of apomorphine developed thromboembolic complications. Both required surgical intervention. Both recovered fully, but what is clear is this therapeutic approach needs further development.
Apomorphine has long been used to treat severe Parkinson’s by bypassing the digestive tract. A multisite study in the United States evaluated the efficacy and safety of apomorphine in 62 patients, half of whom were randomized to placebo and half to the active drug. All had taken apomorphine for at least 3 months, at least twice daily. There was a significant improvement in motor function. Apomorphine also reduced heart rate and blood pressure. Orthostasis occurred in some patients. Dopamine replacement therapy can itself cause postural hypotension, so be careful!
From my research, this all relates to idiopathic Parkinson’s. Now I just need to find out if it’s different for us MSAers. Or find someone who has already tried it. At least I know now that it is insidious and it is not easy to fight it. This apomorphine doesn’t seem to be an everyday pill either.