Current approaches to the treatment of Parkinson's disease

Abstract

Enormous progress has been made in the treatment of Parkinson's disease (PD). As a result of advances in experimental therapeutics, many promising therapies for PD are emerging. Levodopa remains the most potent drug for controlling PD symptoms, yet is associated with significant complications such as the "wearing off" effect, levodopa-induced dyskinesias and other motor complications. Catechol-o-methyl-transferase inhibitors, dopamine agonists and nondopaminergic therapy are alternative modalities in the management of PD and may be used concomitantly with levodopa or one another. The neurosurgical treatment, focusing on deep brain stimulation, is reviewed briefly. Although this review has attempted to highlight the most recent advances in the treatment of PD, it is important to note that new treatments are not necessarily better than the established conventional therapy and that the treatment options must be individualized and tailored to the needs of each individual patient.

Keywords: Parkinson’s disease; deep brain stimulation; levodopa; medical treatment; pallidotomy.

Figure 1

Pharmacologic treatment options available for PD. Abbreviations: BBB, blood-brain barrier; COMT, catechol-O-methyl-transferase; DA, dopamine; L-DOPA, 3,4 dihydroxy-L-phenylamine; HVA, homovanillic acid; 3-MT, 3-methoxytramine; MAO, monoamine oxidase.

Figure 2

Treatment guidelines for the progressive stages of Parkinson’s disease. Abbreviations: COMT, catechol-o-methyl-transferase; DBS, deep brain stimulation; MAO, monoamine oxidase.