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Parkinson's Disease: Motor Fluctuations.

Factor1

  • 1Parkinson's Disease and Movement Disorders Center of Albany Medical Center, 215 Washington Avenue Extension, Albany, NY 12203, USA.

Current Treatment Options in Neurology
|November 30, 2000
PubMed
Summary

Managing Parkinson's disease motor fluctuations involves individualized pharmacologic therapy, including dopamine agonists and COMT inhibitors. Surgical options like deep brain stimulation are reserved for severe, refractory cases after medical treatments fail.

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Area of Science:

  • Neurology
  • Pharmacology

Background:

  • Motor fluctuations are significant late-stage complications in Parkinson's disease (PD) patients treated with levodopa.
  • While numerous pharmacologic and surgical treatments exist, managing these fluctuations can be complex and confusing for clinicians.

Purpose of the Study:

  • To provide guidelines for the pharmacologic management of motor fluctuations in advanced Parkinson's disease.
  • To outline the roles of various adjunctive therapies and surgical interventions for complex cases.

Main Methods:

  • Review of pharmacologic agents including dopamine agonists, COMT inhibitors, MAO-B inhibitors, amantadine, and controlled-release levodopa.
  • Discussion of surgical options such as medial pallidotomy and deep brain stimulation (DBS) for refractory cases.
  • Emphasis on individualized treatment algorithms based on fluctuation patterns and presence of dyskinesia.

Main Results:

  • Pharmacologic therapy is the primary approach, often involving polytherapy with agents like dopamine agonists, COMT inhibitors, MAO-B inhibitors, and amantadine.
  • For simple "wearing off," controlled-release levodopa, COMT inhibitors, MAO inhibitors, and dopamine agonists are options.
  • For complex fluctuations or dyskinesia, specific combinations of dopamine agonists, levodopa, and amantadine are recommended.
  • Surgery is a last resort for patients with severe, medically intractable symptoms.

Conclusions:

  • Individualized pharmacologic management is crucial for treating motor fluctuations in Parkinson's disease.
  • Specialist evaluation is recommended for complicated cases.
  • Surgical interventions should be performed by experienced teams in specialized centers.

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