Sonographic Characterisation of Tissue Changes Associated with Infused Apomorphine Hydrochloride: A Case Series

Abstract

Apomorphine hydrochloride is used to treat refractory motor fluctuations in advanced Parkinson's disease. Delivery by infusion is associated with the formation of hard subcutaneous nodules, which may be painful, limit available infusion sites, and interfere with absorption of the drug. Diagnostic ultrasound was used to image affected tissue in 12 people experiencing apomorphine nodule formations. It revealed significant departures from normality in dermal and subcutaneous tissue, including a variety of nodule appearances, dermal thickening and diffuse changes consistent with inflammatory reactions. Sonographic appearances differed markedly between individuals, but no clear correlation between severity of tissue changes, patient demographics and apomorphine dose was observed. Diagnostic ultrasound may be useful as a non-invasive method of assessing subcutaneous nodule formation, to measure changes in affected tissue over time and after treatment.

Ultrasound treatment of cutaneous side‐effects of infused apomorphine: A randomized controlled pilot study

“…Preliminary investigations by our group demonstrated significant differences in hardness, tenderness, and sonographic appearance of tissue used for apomorphine infusion, when compared with normal tissue (data available from corresponding author). Sonographic changes included focal variations in echogenicity corresponding to palpable nodules, dermal thickening, and diffuse oedematous changes in the adipose tissue 17. Pre‐ and post‐treatment images were compared to identify the extent of change in these variables, using a scoring system in which shrinkage of nodules and normalization of dermal thickness and echogenicity were quantified.…”