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Treatment Options in the Modern Management of Parkinson Disease
Anthony H. V. Schapira, MD, DSc, FRCP, FMedSci
Arch Neurol. 2007;64(8):1083-1088.
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INTRODUCTION
Dopamine replacement therapy with levodopa has been the mainstay of symptomatic treatment of Parkinson disease (PD) for almost 40 years. While this drug remains the "gold standard," several additional dopaminergic drugs have been introduced to provide alternatives for patients with PD. Practical challenges in the management of PD include determining the point at which drug therapy should begin and with what, the sequence and combination of drugs required as the disease progresses, and the place for parenteral therapy and surgery in advanced disease. Although levodopa offers effective symptom relief at all stages, its risk of inducing motor complications has led many to advocate alternative drugs for initiation in suitable patients. Dopamine agonists and monoamine oxidase (MAO) B inhibitors offer effective relief of the motor features of PD in early and more advanced disease and are associated with a low risk for motor . . . [Full Text of this Article]
WHEN TO START SYMPTOMATIC TREATMENT
INITIAL THERAPY
Producing Effective Symptom Control Delaying Motor Complications Individual Patient Characteristics
COMBINATION THERAPY FOR ADVANCING DISEASE
TREATMENT OF ADVANCED DISEASE
NONMOTOR COMPLICATIONS
FUTURE PROSPECTS
CONCLUSIONS
AUTHOR INFORMATION
Author Affiliations: University Department of Clinical Neurosciences, Institute of Neurology, University College London, England; and National Hospital for Neurology and Neurosurgery, Queen Square, London.
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
Timing the initiation of treatment in Parkinson's disease
Grosset and Schapira
J. Neurol. Neurosurg. Psychiatry 2008;79:615-615.
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