Workshop IV: drug treatment guidelines for the long-term management of Parkinson's disease.
An attempt was made to establish a decision algorithm for the treatment of idiopathic Parkinson's disease at various stages and in different subgroups such as akinetic-rigid or tremor dominance type. We suggest treating young patients with selegiline and a dopamine agonist. In the tremor dominance type we use either budipine or a dopamine agonist. Due to levodopa-induced dyskinesia, we try to avoid levodopa in the early stages of the disease and use it only later in more advanced situations in a combination therapy with dopamine agonists. Since IPS is not only based upon dopamine deficiency but also on resulting glutamatergic overstimulation, we advocate the use of a glutamate antagonist such as amantadine or budipine. Catechol-O-methyl inhibitors are very helpful when wearing-off occurs. Anticholinergics are only used in the early stages of tremor-dominant IPS because we fear enhancing the risk of dementia.
Reichmann
H
H
Dept. of Neurology, University of Dresden, Germany.
Sommer
U
U
Fuchs
G
G
Hefter
H
H
Mark
G
G
Müller
T
T
Thümler
R
R
Ulm
G
G
Vieregge
P
P
D000328:Adult; D000367:Age Factors; D000368:Aged; D018450:Disease Progression; D004493:Education; D006801:Humans; D008875:Middle Aged; D010300:Parkinson Disease / Q000188:drug therapy*; D017410:Practice Guidelines as Topic / Q000592:standards