Parkinson's disease: therapeutic choices and timing decisions in patient management. Interview by Wayne Kuznar.
Parkinson's disease is a progressive neurodegenerative disorder characterized by striatal dopaminergic loss. Carbidopa/levodopa is the most effective drug treatment for disease management. It reduces bradykinesia and rigidity, but is less effective against tremor. Whether carbidopa/levodopa should be used at the time of initial diagnosis or delayed until symptoms become disabling is controversial. A clinical trial is in progress to help resolve this dilemma. As carbidopa/levodopa loses efficacy with continued use, adjunct therapies using catechol-O-methyl-transferase inhibitors or dopamine agonists may be considered. In younger patients exhibiting parkinsonian symptoms, dopamine agonists may be used as first-line therapy. A new, reversible surgical intervention known as deep-brain stimulator placement is being used to control disabling tremor in patients not responding to optimal drug therapy.
Stacy
M
M
National Parkinson Foundation, Phoenix, AZ, USA.
D000367:Age Factors; D000368:Aged; D000978:Antiparkinson Agents / Q000145:classification / Q000494:pharmacology / Q000627:therapeutic use*; D001577:Benzophenones / Q000494:pharmacology / Q000627:therapeutic use; D002230:Carbidopa / Q000494:pharmacology / Q000627:therapeutic use; D018450:Disease Progression; D004334:Drug Administration Schedule; D004599:Electric Stimulation Therapy; D006801:Humans; D007980:Levodopa / Q000494:pharmacology / Q000627:therapeutic use; D008875:Middle Aged; D009596:Nitrophenols; D010300:Parkinson Disease / Q000175:diagnosis / Q000188:drug therapy* / Q000378:metabolism / Q000503:physiopathology; D018579:Patient Selection; D012642:Selegiline / Q000494:pharmacology / Q000627:therapeutic use; D013997:Time Factors; D000077867:Tolcapone
D000978:Antiparkinson Agents; D001577:Benzophenones; D009596:Nitrophenols; D012642:Selegiline; D007980:Levodopa; D000077867:Tolcapone; D002230:Carbidopa