title: Practical guidelines for management of Parkinson disease.
abstract: BACKGROUND
  This article describes a specialist's perspective on the challenge of caring for patients with Parkinson disease in a changing American health care environment that places increasing responsibility on primary care physicians.
  
  
  METHODS
  Guidelines were developed by drawing from a combination of personal experience at a large university Parkinson disease clinic, literature review, presentations at various family practice continuing medical education conferences, and involvement as investigator in various clinical trials of drugs used in Parkinson disease treatment.
  
  
  CONCLUSIONS
  From a therapeutic standpoint, Parkinson disease can be divided into three stages--early, nonfluctuating, and fluctuating. Although the same drugs, namely, carbidopa-levodopa preparations, dopamine agonists, and anticholinergic medications, are usually prescribed, their pattern of use, including frequency and dosing, varies depending on the nature of the dominant symptoms and stage of the disease. Management of Parkinson disease requires familiarity with both the disease-related and drug-related components. Optimal functional efficiency for the patient is gained through striking a delicate balance between the drug regimen and the disease-related components.
authors.affiliation: Department of Neurology, Southern Illinois University School of Medicine, Springfield 62794-1316, USA.
authors.forename: B V
authors.initials: BV
authors.lastname: Manyam
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000978:Antiparkinson Agents / Q000494:pharmacology / Q000627:therapeutic use; D004409:Dyskinesia, Drug-Induced / Q000517:prevention & control; D006801:Humans; D007980:Levodopa / Q000494:pharmacology / Q000627:therapeutic use; D008875:Middle Aged; D019635:Neurosurgical Procedures; D010300:Parkinson Disease / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D017410:Practice Guidelines as Topic; D014202:Tremor / Q000188:drug therapy / Q000209:etiology
chemical_list: D000978:Antiparkinson Agents; D007980:Levodopa