[Parkinson therapy 2001, especially apomorphine in idiopathic Parkinson syndrome]

Today (2001) most strategies for Parkinson's disease (PD) are symptomatic. The etiology of the disease is not known. There exists no possibility to inhibit the degeneration of dopaminergic neurons in the substantia nigra. There are hints (but no proofs) for neuroprotection. Beside levodopa a variety of alternative treatment options exists which enable a good and longer lasting control of symptoms (e.g. dopamine agonists, COMT-inhibitors etc.). Apomorphine can reduce off-periods and fluctuations remarkably, even in more advanced stages of PD. Some patients may take profit from neurosurgical procedures (especially deep brain stimulation of subthalamic nucleus and globus pallidus internus). Rehabilitative/supportive approaches complete the medical regime, but there is no proof of efficacy.