Treatment of motor symptoms in advanced Parkinson's disease: A practical approach

• Published in: Progress in neuro-psychopharmacology & biological psychiatry Vol. 35; no. 8; pp. 1795 - 1807
• Main Authors: Maranis, S., Tsouli, S., Konitsiotis, S.
• Format: Journal Article
• Language: English
• Published: Amsterdam Elsevier Inc 01-12-2011; Elsevier
• Subjects: Adult and adolescent clinical studies; Antiparkinson Agents - therapeutic use; Biological and medical sciences; Degenerative and inherited degenerative diseases of the nervous system. Leukodystrophies. Prion diseases; Dopamine agonists; Dopamine Agonists - therapeutic use; Dyskinesia; Dyskinesias - drug therapy; Humans; l-dopa; Levodopa - therapeutic use; Medical sciences; Monoamine oxidase inhibitors; Motor complications; Motor fluctuations; Nervous system (semeiology, syndromes); Nervous system as a whole; Neurology; Neuropharmacology; Organic mental disorders. Neuropsychology; Parkinson Disease - drug therapy; Parkinson's disease; Pharmacology. Drug treatments; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Treatment; APO; PR; Monoamine oxidase inhibitors; AMPA; Parkinson's disease; l-dopa; Dopamine agonists; COMTIs; Motor fluctuations; DBS; NMDA; UPDRS; Motor complications; Dyskinesia; CGI; CI; LID; OD C/L; MAOBIs; WMD; TED; Treatment; PD; 5-HT; DA; Agonist; Motor system disorder; MAO inhibitor; Parkinson disease; Involuntary movement; dopa; Complication; Advanced stage; Degenerative disease; Levodopa; Neurological disorder; Nervous system diseases; Antiparkinson agent; Motor control; Cerebral disorder; Symptomatology; D2 Dopamine receptor; Central nervous system disease; Dopamine agonist; Extrapyramidal syndrome
• ISSN: 0278-5846; 1878-4216
• DOI: 10.1016/j.pnpbp.2011.05.014

Patients with advanced Parkinson's disease (PD) are known to develop motor complications after a few years of levodopa (l-dopa) therapy. Motor fluctuations develop with increasing severity of the disease, owing to loss of dopaminergic neurons and loss of the buffering capacity of the neurons to fluctuating dopamine levels. Dyskinesias develop as a result of pulsatile stimulation of the receptors and alterations in neuronal firing patterns. l-dopa remains the gold standard medication for the treatment of patients with advanced PD. However, once motor complications on l-dopa therapy emerge, clinicians may add on other classes of antiparkinsonian drugs such as dopamine agonists, catechol-O-methyl transferase inhibitors (COMTIs) or monoamine oxidase type B inhibitors (MAOBIs). The individualisation of the treatment seems to be the key for the best approach of advanced PD patients. The present review provides the most important current clinical data in the pharmacological treatment of motor symptoms in advanced PD and provides the clinician a simple algorithm in order to determine the best suitable treatment to advanced parkinsonian patients.
► Patients with advanced Parkinson's disease develop motor complications. ► Motor fluctuations and dyskinesia are difficult to treat. ► Levodopa remains the gold standard in the treatment of patients with advanced PD. ► Add on other classes of antiparkinsonian drugs provide modest relief. ► This review gives updated treatment suggestions for advanced PD.