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Rationale for current therapies in Parkinson's disease.
Expert Opin Pharmacother. 2003 Oct; 4(10):1747-61.EO

Abstract

Parkinson's disease (PD) is a neurodegenerative disorder that affects an estimated 1 million people in the US and tens of millions worldwide. Medication therapy has made significant advances and improvements especially over the last 10 years. A number of new treatments and new strategies have emerged and the quality of life for the average sufferer has improved. This review will describe the rationale and strategies for current medical therapies in PD, with special emphasis on the use of antipsychotic agents. Levodopa remains the most efficacious medication for the management of PD. Long-term use of levodopa, however, is associated with the development of motor fluctuations including dyskinesia. Trials with dopamine agonists have demonstrated a delay in the onset of dyskinesia with the use of this therapy. There is also active, ongoing investigation to determine whether a neuroprotective effect may be present with agonist therapy. Anticholinergics have been successfully used to treat tremor as well as sialorrhoea and urinary urgency. Catechol-O-methyltransferase inhibitors increase 'on time', decrease 'off time,' and improve motor scores. Continuous stimulation of dopamine receptors may decrease the fluctations observed with pulsatile delivery of anti-Parkinsonian medications, but this will require more study. Monoamine oxidase-B inhibitors, specifically selegiline, may provide symptomatic improvement; the question as to whether a neuroprotective benefit is present remains unanswered. Amantadine has demonstrated both symptomatic benefit and dyskinesia benefit in some patients. Selective dopamine blockers such as clozaril and quetiapine, have been shown to be effective in the treatment of psychosis. This class of medications is particularly useful as an adjunctive to levodopa and dopamine agonists. Doses of dopaminergic drugs can be escalated to treat Parkinsonian symptoms, whereas selective dopamine blockers can be added to block psychosis. Old management strategies required a reduction in dopaminergic therapy and therefore worsened Parkinsonian symptoms. Even though there have been great advances in the medical options for symptomatic management of PD, there are still many unmet needs for this patient population.

Authors+Show Affiliations

University of Florida, Department of Neurology, McKnight Brain Institute, PO Box 100236, Gainesville, FL 32610, USA.No affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't
Review

Language

eng

PubMed ID

14521485

Citation

Romrell, Janet, et al. "Rationale for Current Therapies in Parkinson's Disease." Expert Opinion On Pharmacotherapy, vol. 4, no. 10, 2003, pp. 1747-61.
Romrell J, Fernandez HH, Okun MS. Rationale for current therapies in Parkinson's disease. Expert Opin Pharmacother. 2003;4(10):1747-61.
Romrell, J., Fernandez, H. H., & Okun, M. S. (2003). Rationale for current therapies in Parkinson's disease. Expert Opinion On Pharmacotherapy, 4(10), 1747-61.
Romrell J, Fernandez HH, Okun MS. Rationale for Current Therapies in Parkinson's Disease. Expert Opin Pharmacother. 2003;4(10):1747-61. PubMed PMID: 14521485.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Rationale for current therapies in Parkinson's disease. AU - Romrell,Janet, AU - Fernandez,Hubert H, AU - Okun,Michael S, PY - 2003/10/3/pubmed PY - 2003/12/19/medline PY - 2003/10/3/entrez SP - 1747 EP - 61 JF - Expert opinion on pharmacotherapy JO - Expert Opin Pharmacother VL - 4 IS - 10 N2 - Parkinson's disease (PD) is a neurodegenerative disorder that affects an estimated 1 million people in the US and tens of millions worldwide. Medication therapy has made significant advances and improvements especially over the last 10 years. A number of new treatments and new strategies have emerged and the quality of life for the average sufferer has improved. This review will describe the rationale and strategies for current medical therapies in PD, with special emphasis on the use of antipsychotic agents. Levodopa remains the most efficacious medication for the management of PD. Long-term use of levodopa, however, is associated with the development of motor fluctuations including dyskinesia. Trials with dopamine agonists have demonstrated a delay in the onset of dyskinesia with the use of this therapy. There is also active, ongoing investigation to determine whether a neuroprotective effect may be present with agonist therapy. Anticholinergics have been successfully used to treat tremor as well as sialorrhoea and urinary urgency. Catechol-O-methyltransferase inhibitors increase 'on time', decrease 'off time,' and improve motor scores. Continuous stimulation of dopamine receptors may decrease the fluctations observed with pulsatile delivery of anti-Parkinsonian medications, but this will require more study. Monoamine oxidase-B inhibitors, specifically selegiline, may provide symptomatic improvement; the question as to whether a neuroprotective benefit is present remains unanswered. Amantadine has demonstrated both symptomatic benefit and dyskinesia benefit in some patients. Selective dopamine blockers such as clozaril and quetiapine, have been shown to be effective in the treatment of psychosis. This class of medications is particularly useful as an adjunctive to levodopa and dopamine agonists. Doses of dopaminergic drugs can be escalated to treat Parkinsonian symptoms, whereas selective dopamine blockers can be added to block psychosis. Old management strategies required a reduction in dopaminergic therapy and therefore worsened Parkinsonian symptoms. Even though there have been great advances in the medical options for symptomatic management of PD, there are still many unmet needs for this patient population. SN - 1465-6566 UR - https://www.unboundmedicine.com/medline/citation/14521485/Rationale_for_current_therapies_in_Parkinson's_disease_ L2 - https://www.tandfonline.com/doi/full/10.1517/14656566.4.10.1747 DB - PRIME DP - Unbound Medicine ER -