Which factors influence therapeutic decisions in Parkinson's disease?
Development of dyskinesia is a common phenomenon during the long-term course of Parkinson's disease. During the last few years, some but not all pathogenetic mechanisms causing dyskinesias in PD have become better understood. Severity of Parkinson's disease and levodopa dosing are the main clinical risk factors. Most concepts underline the significance of pulsatile D1-receptor stimulation for the development of dyskinesias. The interactions between D1- and D2-mediated STR-Gpi pathways and colocalized neuropeptides are important but not fully understood. Glutamatergic overactivity might also be a significant pathogenetic factor. According to these pathophysiological concepts, therapeutic strategies focus mainly on continuous postsynaptic DA-receptor stimulation by long-acting DA-agonists or highly selective D2-agonists. Another strategy is the use of NMDA antagonists.
Baas
H
H
Department of Neurology, City Hospital Hanau, Leimenstr. 20, 63450 Hanau, Germany. Baas@em.uni-frankfurt.de
Fuchs
G
G
Gemende
I
I
Hueber
R
R
Lachenmayer
L
L
Schneider
E
E
Schoenberger
B
B
Werner
M
M
D000367:Age Factors; D018491:Dopamine Agonists / Q000627:therapeutic use*; D004347:Drug Interactions; D020820:Dyskinesias / Q000628:therapy; D019317:Evidence-Based Medicine; D018691:Excitatory Amino Acid Antagonists / Q000627:therapeutic use; D017048:Health Care Costs; D006801:Humans; D007980:Levodopa / Q000627:therapeutic use; D018696:Neuroprotective Agents / Q000627:therapeutic use; D010300:Parkinson Disease / Q000628:therapy*; D011788:Quality of Life; D017448:Receptors, Dopamine D2 / Q000819:agonists; D016194:Receptors, N-Methyl-D-Aspartate / Q000037:antagonists & inhibitors; D012307:Risk Factors
D018491:Dopamine Agonists; D018691:Excitatory Amino Acid Antagonists; D018696:Neuroprotective Agents; D017448:Receptors, Dopamine D2; D016194:Receptors, N-Methyl-D-Aspartate; D007980:Levodopa