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Review
. 2025 May;43(2):341-363.
doi: 10.1016/j.ncl.2024.12.010. Epub 2025 Jan 22.

Treatment of Motor Symptoms of Parkinson's Disease

Luca Marsili  1 , Matteo Bologna  2 , Lily Y Chen  3 , Alberto J Espay  4
Affiliations
Review

Treatment of Motor Symptoms of Parkinson's Disease

Luca Marsili et al. Neurol Clin. 2025 May.

Abstract

The most effective pharmacologic intervention used to treat motor symptoms in Parkinson's disease is levodopa, which is available in various formulations, including newer continuous subcutaneous infusions. Dopamine agonists, monoamine oxidase-B enzyme inhibitors, catechol-O-methyltransferase enzyme inhibitors, amantadine, istradefylline, and anticholinergics can be used as adjuncts to levodopa. With disease progression, pharmacologic interventions alone may not suffice to manage motor symptoms, making it necessary to consider device-aided therapies (eg, levodopa-carbidopa intestinal gel infusion, continuous subcutaneous infusions of apomorphine, levodopa, or foslevodopa) or invasive surgical techniques (eg, deep brain stimulation or MRI-guided high-frequency focused ultrasound).

Keywords: Deep brain stimulation; Device-aided therapies; Dopamine agonists; Levodopa; MRI-guided high-frequency focused ultrasound; Parkinson’s disease; Therapy.

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Conflict of interest statement

Disclosures No specific funding was received for this work. The authors declare that there are no conflicts of interest relevant to this work. Dr L. Marsili has received honoraria from the International Association of Parkinsonism and Related Disorders Society for social media and Web support. Dr L. Marsili has received a grant (collaborative research agreement) from the International Parkinson and Movement Disorders Society for the MDS-UTRS Validation Program (Role: PI), Non-Profit. Drs M. Bologna and L.Y. Chen have nothing to report. Dr A.J. Espay has received grant support from the NIH, United States and the Michael J. Fox Foundation, United States; personal compensation as a consultant/scientific advisory board member for Neuroderm, Amneal, Acadia, Avion Pharmaceuticals, Acorda, Kyowa Kirin, Supernus (formerly, USWorldMeds), NeuroDiagnostics, Inc (SYNAPS Dx), Intrance Medical Systems, Inc., Praxis Precision Medicines, and Herantis Pharma; and publishing royalties from Lippincott Williams & Wilkins, Cambridge University Press, and Springer. He cofounded REGAIN Therapeutics and is coinventor of the patent “compositions and methods for treatment and/or prophylaxis of proteinopathies.” He serves on the editorial boards of the Journal of Parkinson’s Disease, Journal of Alzheimer’s Disease, European Journal of Neurology, Movement Disorders Clinical Practice, and JAMA Neurology.

MeSH terms