Therapies in Parkinson's disease.
OBJECTIVE
This review examines currently available therapeutic strategies for Parkinson's disease, emphasizing evidence-based data as well as a patient-centered approach to the treatment of motor and nonmotor symptoms.


RESULTS
Although clinical trials of disease-modifying approaches have been thus far disappointing, steady advances are being made in the symptomatic treatment of Parkinson's disease. In this review, we focus on recent studies with monoamine oxidase type B inhibitors (selegiline and rasagiline), coenzyme Q10, creatine, and exercise in early Parkinson's disease. We also discuss the relative merits and disadvantages of delaying the initiation of levodopa therapy, the role of dopamine agonists, particularly ropinirole and pramipexole, and management of motor and behavioral complications, such as fluctuations, dyskinesias and impulse-control disorders. Novel formulations and delivery approaches for conventional and new drugs are also discussed. Finally, we review recent studies of surgical treatments of Parkinson's disease, such as deep brain stimulation.


CONCLUSIONS
Numerous clinical trials have provided evidence that health-related quality of life can be substantially improved with early diagnosis and institution of exercise and other physical measures, appropriate timing of dopaminergic therapy, and strategies to delay and treat levodopa-related motor complications and nonmotor Parkinson's disease-related symptoms.
Department of Neurology, Parkinson's Disease Center and Movement Disorders Clinic, Baylor College of Medicine, Houston, Texas 77030, USA. josephj@bcm.edu
Joseph
J
Jankovic
Werner
W
Poewe
D000978:Antiparkinson Agents / Q000627:therapeutic use*; D046690:Deep Brain Stimulation / Q000379:methods*; D007174:Disruptive, Impulse Control, and Conduct Disorders; D006801:Humans; D019636:Neurodegenerative Diseases / Q000209:etiology / Q000628:therapy; D010300:Parkinson Disease / Q000150:complications / Q000628:therapy*
D000978:Antiparkinson Agents