Bloqueos de la marcha sin respuesta al estímulo dopaminérgico con apomorfina en pacientes parkinsonianos graves

Abstract

IntroductionFreezing of gait unresponsive to dopaminergic stimulation in patients with severe Parkinsonism. The freezing of gait episodes (FOG) normally appear during the “off” period and generally improve with dopaminergic stimulus, at the same time as improving other Parkinsonian symptoms. Patients and methodsWe report a group of 10 patients with severe Parkinson’s disease. All patients suffered motor fluctuations, dyskinesias and episodes of FOG during the “on” and “off” state. The patients received a subcutaneous apomorphine bolus, without other dopaminergic medication; an effective dose of apomorphine was considered as one that induced a reduction of at least a 60% in the UPDRS motor scale. ResultsThe baseline motor UPDRS was 61.3±4.7, which dropped to 21±4.3 after the apomorphine injection. The mean dose of apomorphine was 5.5mg (3-7mg). The bolus of apomorphine improved the parameters of the gait related to bradykinesia and the tapping tests of the limbs, but the episodes of FOG did not vary significantly between the “off” and “on” state. ConclusionsWe present a group of 10 patients with freezing of gait episodes that did not improve with treatment and persisted during the “on” period induced by dopaminergic stimulus with apomorphine.