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Review
. 2020 May;38(2):255-267.
doi: 10.1016/j.ncl.2019.12.002. Epub 2020 Feb 20.

Pharmacologic Treatment of Motor Symptoms Associated with Parkinson Disease

Werner Poewe  1 , Philipp Mahlknecht  2
Affiliations
Review

Pharmacologic Treatment of Motor Symptoms Associated with Parkinson Disease

Werner Poewe et al. Neurol Clin. 2020 May.

Abstract

The cardinal motor features of Parkinson disease (PD) are driven by striatal dopamine deficiency. Pharmacologic dopamine substitution is the mainstay of drug treatment of PD. Levodopa is still the most efficacious drug to treat PD motor symptoms. MAO-B inhibitors and dopamine agonists are useful options. The main limitation of levodopa is the development of motor response fluctuations and drug-induced dyskinesias. Adjunct MAO-B and COMT inhibitors as well as dopamine agonists and continuous infusions of levodopa intestinal gel or subcutaneous apomorphine are efficacious in reducing motor fluctuations and amantadine is the only drug with established efficacy in reducing dyskinesias.

Keywords: Dopamine; Dyskinesia; Guideline; Motor fluctuations; Movement disorders society (MDS) evidence-based medicine (EBM) review update; Parkinson disease (PD); Recommendation; Treatment.

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Conflict of interest statement

Disclosure W. Poewe has received consultancy and lecture fees in relation to clinical drug programs for PD from AbbVie, AstraZeneca, BIAL, Biogen, Biohaven, Britannia, Grünenthal, Intec, Ipsen, Lundbeck, Novartis, Neuroderm, Orion Pharma, Oxford Biomedica, Prexton, Regenera, Roche, Sunovion, Sun Pharma, Takeda, Teva, UCB and Zambon. Royalties: Thieme, Wiley Blackwell, Oxford University Press and Cambridge University Press. P. Mahlknecht has received an educational grant from Medtronic.

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