title: Motor complications in Parkinson's disease: a comprehensive review of emergent management strategies.
abstract: Motor complications (dyskinesias and motor fluctuations) are a common and disabling problem of dopaminergic therapy in Parkinson's disease, which are often difficult to treat with the current therapeutic strategies. It has been proposed that continuous dopaminergic delivery could reduce the emergence of motor complications, which has been tried with levodopa intestinal infusion or subcutaneous apomorphine infusion. In selected refractory cases, surgical approaches such as deep brain stimulation should be considered. Ongoing clinical and preclinical research tried to lead the field into the discovery of other therapeutic targets and strategies that might prevent or reduce motor complications. These include drugs targeting non-dopaminergic systems (e.g. glutamatergic, serotonergic, noradrenergic, adenosinergic and cholinergic systems), gene therapy for delivering neurotrophic factors or critical enzymes for dopamine synthesis, and cell therapy. These studies found variable results, some of them promising, with the possibility of new therapeutic armamentarium in the management of Parkinson's disease in the near future.
authors.affiliation: Movement Disorders and Functional Surgery Unit, Department of Neurology, Centro Hospitalar São João, Alameda Prof. Hernâni Monteiro, 4200-139 Porto, Portugal. jmassano@med.up.pt.
authors.forename: Susana
authors.initials: S
authors.lastname: Marques de Sousa
authors.forename: João
authors.initials: J
authors.lastname: Massano
mesh_terms: D064987:Cell- and Tissue-Based Therapy; D018679:Cholinergic Agonists / Q000627:therapeutic use; D046690:Deep Brain Stimulation; D018491:Dopamine Agonists / Q000627:therapeutic use; D018690:Excitatory Amino Acid Agonists / Q000627:therapeutic use; D015316:Genetic Therapy; D006801:Humans; D058990:Molecular Targeted Therapy; D009069:Movement Disorders / Q000150:complications* / Q000188:drug therapy / Q000628:therapy*; D010300:Parkinson Disease / Q000150:complications* / Q000188:drug therapy / Q000628:therapy*; D058913:Purinergic Agonists / Q000627:therapeutic use; D017366:Serotonin Receptor Agonists / Q000627:therapeutic use
chemical_list: D018679:Cholinergic Agonists; D018491:Dopamine Agonists; D018690:Excitatory Amino Acid Agonists; D058913:Purinergic Agonists; D017366:Serotonin Receptor Agonists