title: A comprehensive approach to Parkinson's disease. How to manage fluctuating motor and nonmotor symptoms.
abstract: Parkinson's disease is challenging to diagnose and treat. Patients are subject to wide fluctuations of motor status as well as an array of nonmotor complications that may be as debilitating as their motor counterparts, or even more debilitating. Levodopa remains the most effective agent for relief of motor symptoms, but long-term levodopa use is associated with development of motor complications, including severe dyskinesias. For this reason, selegiline or a dopamine agonist may be preferred as initial therapy. Carbidopa/levodopa (with or without a COMT inhibitor) can be added within 5 years or as required for relief of motor symptoms. When medical therapy can no longer provide adequate symptom control, surgical intervention needs to be considered.
authors.affiliation: Cabarrus/Northeast Medical Center Family Medicine, Charlotte, North Carolina, USA. ozdoc@aol.com
authors.forename: Stephen
authors.initials: S
authors.lastname: Brunton
mesh_terms: D000978:Antiparkinson Agents / Q000627:therapeutic use*; D003937:Diagnosis, Differential; D006801:Humans; D010300:Parkinson Disease / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D016896:Treatment Outcome; D014202:Tremor / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology
chemical_list: D000978:Antiparkinson Agents