Novel drugs for Parkinson's disease

Treatment options in PD have expanded remarkably in the past several years. Three new drugs were approved for use in the United States just within the 9 months preceding the preparation of this article. Several new compounds are in the pipeline. Nevertheless, the unmet needs of PD patients are readily apparent in any busy clinical practice. These needs can be posed as three deceivingly simple questions: 1. When and how should L-dopa be started? Despite the fact that L-dopa remains the mainstay of PD therapy after 30 years' time, lacking is a fundamental understanding of proper usage and avoidance of long-term complications. 2. What can be done about cognitive decline and dementia in PD? The current answer is nothing. Efforts are just beginning to fill this large void in knowledge and provide adequate treatment for this disabling problem. 3. How can PD be prevented? This question cannot be answered because the cause of PD remains uncertain. The dearth of substantive information available on this topic is evidenced in this article. The bulk of text appears under the heading Symptomatic Treatments, whereas only a few speculative comments can be offered under the heading Preventive Treatments. The paramount need for expanded resources and dedicated efforts to identify the causes and devise preventions must be met if advances in the treatment of PD are to be made in the twenty-first century.