Treatment of Motor Symptoms of Parkinson's Disease

The most effective pharmacologic intervention used to treat motor symptoms in Parkinson's disease is levodopa, which is available in various formulations, including newer continuous subcutaneous infusions. Dopamine agonists, monoamine oxidase-B enzyme inhibitors, catechol-O-methyltransferase enzyme inhibitors, amantadine, istradefylline, and anticholinergics can be used as adjuncts to levodopa. With disease progression, pharmacologic interventions alone may not suffice to manage motor symptoms, making it necessary to consider device-aided therapies (eg, levodopa-carbidopa intestinal gel infusion, continuous subcutaneous infusions of apomorphine, levodopa, or foslevodopa) or invasive surgical techniques (eg, deep brain stimulation or MRI-guided high-frequency focused ultrasound).