A comprehensive approach to Parkinson's disease. How to manage fluctuating motor and nonmotor symptoms

Parkinson's disease is challenging to diagnose and treat. Patients are subject to wide fluctuations of motor status as well as an array of nonmotor complications that may be as debilitating as their motor counterparts, or even more debilitating. Levodopa remains the most effective agent for relief of motor symptoms, but long-term levodopa use is associated with development of motor complications, including severe dyskinesias. For this reason, selegiline or a dopamine agonist may be preferred as initial therapy. Carbidopa/levodopa (with or without a COMT inhibitor) can be added within 5 years or as required for relief of motor symptoms. When medical therapy can no longer provide adequate symptom control, surgical intervention needs to be considered.