Parkinson’s Disease – Treatment Principles

Treatment approaches for Parkinson’s disease include pharmacological, non-pharmacological and surgical methods, as highlighted on the slide and in the rest of the presentation.^1-7

References:
1. Stocchi F. Conventional treatment-related motor complications: their preventi…

Once swallowed, orally-administered levodopa moves down the gastrointestinal tract – a process sometimes delayed in PD due to impaired gastric motility – until it is absorbed into the blood via the duodenum.² From the circulation, levodopa eventually makes its way to the …

The slide shows the mechanism of action of levodopa, when taken in combination with a dopa decarboxylase inhibitor (DDI). Levodopa can be metabolized to dopamine on either side of the blood–brain barrier.¹ It is therefore usually administered with a DDI and with a catecho…

Although levodopa has been a major success story for the management of PD, it does have some limitations, such as the development of dopa-related response fluctuations (both motor and non-motor) and drug-induced dyskinesias.⁴

A single dose of levodopa/decarboxylase inhibi…

Levodopa is the major symptomatic therapy for PD and provides benefit to virtually all patients.¹ During the early stage, the effects of levodopa tend to be long-lasting, and motor complications usually take a long time to develop.¹ Beyond this early stage, however, patie…

Whilst the above image shows a typical pattern of levodopa-related motor fluctuations and dyskinesias, adjunctive treatments can prolong ON time, reduce OFF time, and ameliorate dyskinesias.^1,3

References:
1. Stacy M. Medical treatment of Parkinson disease. Neurol Clin 20…

Dopamine agonists play a major role in the treatment of PD.⁶ They act by directly stimulating intact postsynaptic receptors in the brain linked to motor control.⁶ Although they tend to be less potent than levodopa in reducing parkinsonian motor symptoms, dopamine agonists…

Patients who are experiencing ‘wearing-off’ may benefit from taking a monoamine oxidase type B inhibitor (MAO-B inhibitor).^5,6 MAO-B inhibitors inhibit the breakdown of either dopamine or levodopa in the body, thus prolonging their therapeutic effect and time spent in ‘ON…

Patients who are experiencing ‘wearing-off’ may benefit from taking a catechol-O-methyltransferase inhibitor (COMT inhibitor).^3,4 COMT inhibitors inhibit the breakdown of dopamine and of levodopa in the body, thus prolonging their therapeutic effect and time spent in ‘ON’…

Certain non-dopaminergic agents help to reduce dyskinesias,⁶ but have the limitation of worsening side effects, such as hallucinations and psychosis, in some individuals.⁷ Non-dopaminergic agents have also been licensed for patients with moderate to advanced PD experienci…