title: Treatment of advanced Parkinson's disease.
abstract: Parkinson's disease is a progressive neurological disorder characterized by tremor, bradykinesia, rigidity, gait and postural instability and a variety of nonmotor symptoms. While these and other motor signs typically improve with levodopa, the so-called axial signs, such as dysarthria, dysphagia, postural instability and freezing, and most nonmotor signs, such as depression, cognitive decline and dysautonomia, usually do not respond satisfactorily to levodopa. Furthermore, the use of levodopa may be limited by the development of motor fluctuations, dyskinesias and other adverse effects. This manuscript reviews the medical management of advanced Parkinson's disease, focusing on the treatment of motor fluctuations and dyskinesias and of nonmotor and nonlevodopa responsive symptoms.
authors.affiliation: Movement Disorder Clinic, Colorado Neurologic Institute, 701 East Hampden Ave. Suite 330 Englewood, CO 80113, USA. Neurodoc01@sbcglobal.net
authors.forename: Alan
authors.initials: A
authors.lastname: Diamond
authors.forename: Joseph
authors.initials: J
authors.lastname: Jankovic
mesh_terms: D000978:Antiparkinson Agents / Q000627:therapeutic use*; D001342:Autonomic Nervous System Diseases / Q000209:etiology; D003072:Cognition Disorders / Q000209:etiology; D006801:Humans; D007980:Levodopa / Q000009:adverse effects / Q000627:therapeutic use; D001523:Mental Disorders / Q000209:etiology; D010300:Parkinson Disease / Q000188:drug therapy* / Q000503:physiopathology; D012893:Sleep Wake Disorders / Q000209:etiology
chemical_list: D000978:Antiparkinson Agents; D007980:Levodopa