Clinical experience in the treatment of motor fluctuations in Parkinson's disease. Delphi consensus of a group of experts in movement disorders

• Published in: Revista de neurologiá Vol. 71; no. 11; pp. 407 - 420
• Main Authors: Rodríguez-Sanz, A, Peña-Llamas, E, Alonso-Cánovas, A, Alonso-Frech, F A, Borrue-Fernández, C, Catalán, M J, Fanjul-Arbós, S, García-Cobos, E, García-Ramos, R, García Ruiz-Espiga, P, Herreros-Rodríguez, J, Kurtis-Urra, M, López-Lozano, J J, López-Manzanares, L, Martínez-Castrillo, J C, Martínez-Fernández, R, Mata, M, Pérez-Sánchez, J R, Posada, I J, Rojo, A, Romero-Muñoz, J P, Ruiz-Huete, C, Sánchez-Alonso, M P, Vivancos-Matellano, F, En Representación Del Grupo de Trastornos Del Movimiento de la Asociación Madrileña de Neurología, En Representación Del Grupo de Trastornos Del Movimiento de la Asociación Madrileña de Neurología
• Format: Journal Article
• Language: Spanish
• Published: 01-12-2020
• ISSN: 1576-6578
• DOI: 10.33588/rn.7111.2020088

INTRODUCTIONMotor fluctuations are one of the most common complications of Parkinson's disease and their treatment is still a complex matter. Therefore, from the Neurology Movement Disorders Group we present our clinical experience in the treatment of these complications, with the intention of it being useful in decision-making in daily clinical practice. DEVELOPMENTNineteen questions were developed based on a literature review and an open survey answered by members of this group. These issues were discussed in two phases, using the Delphi methodology. Considering the results of the survey, levodopa dose adjustment and dopamine agonists are the option with the best efficacy/tolerability ratio in the treatment of motor fluctuations. Rotigotine is useful in the motor fluctuations associated with gastroparesis, and intermittent subcutaneous apomorphine has positive effects in patients with unpredictable off periods. The most relevant adverse effect associated with dopamine agonists is impulse control disorder. Catechol-O-methyltransferase inhibitors are useful in the initial stages of motor fluctuations, especially in wearing off. Monoamine oxidase inhibitors are generally drugs that are well-tolerated and useful in motor fluctuations. If these measures are not effective, second-line treatments should be indicated on a case-by-case basis. CONCLUSIONThe clinical profile of patients with Parkinson's disease is paramount in deciding the most appropriate therapy for the treatment of motor fluctuations.