Nondopaminergic therapy of motor and nonmotor symptoms in Parkinson's disease: a clinician's perspective.
Patients with Parkinson's disease suffer from impaired motor behavior due to the dopaminergic striatal deficit and nonmotor symptoms, which also result from nondopaminergic neuronal death. This review provides a personal opinion on treatment strategies for symptoms, resulting at least partially from nondopaminergic neurodegeneration, and on therapeutic modulation of dopaminergic neurotransmission. Patient-tailored treatment regimes on the basis of an individual risk benefit ratio as essential precondition try to balance all these symptoms. Individually varying heterogeneity of symptoms, nonlinear disease progression, treatment response, acceptance, tolerability and safety of applied therapies demand a close, consistent relationship between patient and treating physician. Daily maintenance of patients does not ask for too detailed treatment guidelines.
Department of Neurology, St. Joseph Hospital Berlin-Weißensee, Gartenstr. 1, 13088 Berlin, Germany.
Thomas
T
Müller
D018450:Disease Progression; D006801:Humans; D009410:Nerve Degeneration / Q000150:complications; D010300:Parkinson Disease / Q000150:complications / Q000473:pathology / Q000628:therapy*; D057285:Precision Medicine / Q000379:methods; D009435:Synaptic Transmission / Q000502:physiology
Parkinson's disease; deep brain stimulation; nondopaminergic pharmacotherapy; nonmotor symptoms; repair; repulsive guidance molecule A