Treatment of parkinsonian syndromes in developing countries

Parkinsonism is the commonest extrapyramidal disorder. The condition arises when the striatonigral dopamine content falls below a critical value. The principle of treatment is dopamine replacement or counteracting the effects of acetycholine, the neurotransmitter which is in abundance. The choice of drug is determined by availability, cost, and side effects. The most commonly prescribed drugs in developing countries are the anticholinergics, which are the least expensive. The dopamine-replacement agents are second-line drugs and it appears as if low doses are effective in improving rigidity, gait abnormality, and postural instability. The use of dopa-agonist drugs is more limited, because of cost and side effects. Surgical management of cases is still in its infancy in developing countries. This review also highlights the more recent modes of management practised mainly in developed countries.