Parkinson's disease medical therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Medical Therapy

The mainstay of therapy for motor symptoms of Parkinson disease are:

• Levodopa: This drug is the most effective in controlling motor symptoms in PD patients (2_8). If we use levodopa alone, it will convert to dopamine in the peripheral circulation, so we combine it with a decarboxylase inhibitor like carbidopa to prevent this. The ratio of carbidopa_levodopa in tablets are 10/100, 25/100 or 25/250.(9_10) The adverse effects of this drug includes elevated serum homocysteine, low levels of vitamin B12, elevated methylmalonic acid and sensorimotor peripheral neuropathy.(17 ta 20) It can also cause motor fluctuations, dyskinesia, cramps and dystonia.(21_22) One of the concerns regarding long term use of levodopa is that it may be increase the rate of dopamine neurons degeneration(37) but other studies demonstrated  that it does not damage neurons.(39_40)

• Dopamine agonists:
• Monoamine oxidase (MAO) B inhibitors:
• Anticholinergic agents:
• Amantadine:
• Catechol-O-methyl transferase (COMT) inhibitors:
• Estrogen:
• Other agents:

Treatment choices for some of the nonmotor symptoms of PD are:

• Psychosis:
• Dementia:
• Daytime sleepiness:
• Fatigue:
• Depression:
• Constipation:
• Sialorrhea:
• Rhinorrhea:
• Sexual dysfunction:
• Ortostatic hypotention: