Adjunctive Therapies in Parkinson's Disease: How to Choose the Best Treatment Strategy Approach.

Abstract

End-of-dose motor fluctuations are regarded as one of the core troublesome symptoms by patients with Parkinson's disease (PD). Treatment of levodopa (L-dopa)-induced motor fluctuations is still an unmet medical need. L-dopa is the gold standard in the treatment of motor PD symptoms; notwithstanding, a wide range of adjunct therapies are currently available for the treatment of end-of-dose motor fluctuations. Additionally, device-aided therapies, such as deep brain stimulation, L-dopa-carbidopa intestinal gel infusion, and on-demand injection or continuous apomorphine infusion, may be considered when oral treatments are not sufficient to control motor fluctuations. In spite of the several evidence-based reviews and guidelines available, there is no agreement on which add-on therapy should be started first or its optimal timing. Equally challenging is the choice and timing between device-aided therapies. Herein, we propose a general overview of oral and device-aided treatments for PD patients with end-of-dose motor fluctuations, offering two possible algorithms that can guide clinicians during the therapeutic decision process.

• Authors: Margherita Fabbri, Mario M Rosa, Joaquim J Ferreira
• Journal: Drugs & aging (Drugs Aging) Vol. 35 Issue 12 Pg. 1041-1054 (12 2018) ISSN: 1179-1969 [Electronic] New Zealand
• PMID: 30318555 (Publication Type: Journal Article, Review)

Chemical References

• Antiparkinson Agents
• Drug Combinations
• carbidopa, levodopa drug combination
• Levodopa
• Carbidopa

Topics

• Algorithms
• Antiparkinson Agents (administration & dosage, therapeutic use)
• Carbidopa (administration & dosage)
• Combined Modality Therapy
• Deep Brain Stimulation (methods)
• Drug Combinations
• Humans
• Levodopa (administration & dosage)
• Parkinson Disease (physiopathology, therapy)