Pharmacologic Treatment of Motor Symptoms Associated with Parkinson Disease

The cardinal motor features of Parkinson disease (PD) are driven by striatal dopamine deficiency. Pharmacologic dopamine substitution is the mainstay of drug treatment of PD. Levodopa is still the most efficacious drug to treat PD motor symptoms. MAO-B inhibitors and dopamine agonists are useful options. The main limitation of levodopa is the development of motor response fluctuations and drug-induced dyskinesias. Adjunct MAO-B and COMT inhibitors as well as dopamine agonists and continuous infusions of levodopa intestinal gel or subcutaneous apomorphine are efficacious in reducing motor fluctuations and amantadine is the only drug with established efficacy in reducing dyskinesias.