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. 2024 Nov;271(11):7071-7101.
doi: 10.1007/s00415-024-12632-6. Epub 2024 Aug 29.

Pharmacotherapy of motor symptoms in early and mid-stage Parkinson's disease: guideline "Parkinson's disease" of the German Society of Neurology

Matthias Höllerhage  1 , Jos Becktepe  2 , Joseph Classen  3 , Günther Deuschl  2 , Georg Ebersbach  4 , Franziska Hopfner  5 , Paul Lingor  6   7   8 , Matthias Löhle  9   10 , Sylvia Maaß  8 , Monika Pötter-Nerger  11 , Per Odin  12   13 , Dirk Woitalla  14 ; German Parkinson’s Guidelines Group; Claudia Trenkwalder  15   16 , Günter U Höglinger  17   18   19
Collaborators, Affiliations

Pharmacotherapy of motor symptoms in early and mid-stage Parkinson's disease: guideline "Parkinson's disease" of the German Society of Neurology

Matthias Höllerhage et al. J Neurol. 2024 Nov.

Abstract

Background and objective: There are multiple pharmacological treatment options for motor symptoms of Parkinson's disease (PD). These comprise multiple drug classes which are approved for the condition, including levodopa, dopamine agonists, COMT inhibitors, MAO-B inhibitors, NMDA-receptor antagonists, anticholinergics, and others. Some of the drugs are approved for monotherapy and combination therapy while others are only approved as adjunctive therapy to levodopa. Furthermore, treatment for special treatment situations, e.g., rescue medication for off-phases, for tremor, treatment during pregnancy and breast feeding is discussed and recommendations are given with further details.

Methods: The recommendations were based on systematic literature reviews, drafted by expert teams, consented in online polls followed by online consensus meetings of the whole German Parkinson's Guideline Group, and publicly released in November 2023.

Results: In the new S2k (i.e., consensus-based) guidelines, the pharmacotherapy of the motor symptoms of PD is discussed in five chapters. These comprise "Parkinson medication", "Initial monotherapy", "Early combination therapy", "Fluctuations and dyskinesia", and "Parkinsonian tremor". Furthermore, there is a chapter for special treatment situations, including perioperative management, freezing of gait, and pregnancy and breastfeeding.

Conclusion: The recommendations for the pharmacotherapy of motor symptoms of PD have been updated. Newly available drugs have been added, while other drugs (e.g., ergoline dopamine agonists, anticholinergics, budipine) have been removed from the recommendations.

Keywords: Guidelines; Parkinson's disease; Pharmacotherapy.

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Conflict of interest statement

Declarations Conflicts of interest Jos Becktepe served as a consultant for Jazz Pharmaceuticals and Neuraxpharm; received honoraria for scientific presentations from Ipsen; received research support from Stratmann; Günther Deuschl served as a consultant for Boston Scientific, Cavion and Insightec; received publication royalties from Thieme; received funding from the German Research Council (SFB 1261, T1) and private foundations. Georg Ebersbach served as a consultant for AbbVie, BIAL, Desitin, STADAa, ESTEVE, Neuraxpharm, Boehringer; received honoraria for scientific presentations from AbbVie, BIAL, Britannia, Desitin, ESTEVE, Licher, STADA, Zambon; received publication royalties from Kohlhammer, Thieme, and Springer. Matthias Höllerhage served as a consultant for AbbVie; received honoraria for scientific presentations from AbbVie; received publication royalties from Thieme. Günter Höglinger has ongoing research collaborations with Roche, UCB, AbbVie; served as a consultant for Abbvie, Alzprotect, Amylyx, Aprinoia, Asceneuron, Bayer, Bial, Biogen, Biohaven, Epidarex, Ferrer, Kyowa Kirin, Lundbeck, Novartis, Retrotope, Roche, Sanofi, Servier, Takeda, Teva, UCB; received honoraria for scientific presentations from AbbVie, Bayer, Bial, Biogen, Bristol Myers Squibb, Esteve, Kyowa Kirin, Pfizer, Roche, Teva, UCB, Zambon. received publication royalties from Academic Press, Kohlhammer, and Thieme. Dirk Woitalla served as a consultant for AbbVie, Bial, Esteve, StadaPharm, Zambone; received honoraria for scientific presentations from AbbVie, Daiichi, Desitin, Esteve, UCB, Zambone. All other authors declared no conflict of interest.

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