Too many treatments for Parkinson's disease: how should they be used?
Surgical ablation for Parkinson's disease was abandoned in the 1970s after successful clinical trials of L-DOPA and L-DOPA/decarboxylase inhibitor combinations and early dopamine receptor agonists were added to prolong a viable therapeutic window beyond 5 years. The development of newer agonists with variations in receptor subtype specificity and new enzyme inhibitors with combinations of central and peripheral effects have continued to attract attention as therapeutic alternatives. Treatment options are now coming full circle with a rebirth of stereotactic neurosurgical alternatives to a wide variety of pharmacologic paradigms. The authors propose a rationale for selecting differing treatment options within historical perspective and modern treatment goals using both medical and surgical alternatives.
Reynolds
N C
NC
Department of Neurology, Medical College of Wisconsin, Milwaukee, USA.
Terry
L C
LC
Mark
L P
LP
Prieto
T E
TE
Mueller
W R
WR
D000978:Antiparkinson Agents / Q000627:therapeutic use*; D002230:Carbidopa / Q000627:therapeutic use; D003657:Decision Making; D004338:Drug Combinations; D006801:Humans; D007980:Levodopa / Q000627:therapeutic use; D019635:Neurosurgical Procedures / Q000379:methods / Q000639:trends; D010300:Parkinson Disease / Q000188:drug therapy* / Q000601:surgery*; D013238:Stereotaxic Techniques
D000978:Antiparkinson Agents; D004338:Drug Combinations; C009265:carbidopa, levodopa drug combination; D007980:Levodopa; D002230:Carbidopa