Initiating treatment for idiopathic parkinsonism

The initial decision in the management of idiopathic parkinsonism is whether any pharmacotherapy is indicated. There is no conclusive evidence that treatment is helpful before symptoms start to affect the patient's life, although some neurologists believe that deprenyl, also known as selegiline, could be useful. Once functional deficits begin to interfere with the patient's work or social activities, treating symptoms becomes appropriate. Anticholinergics and amantadine can be used, but their limited benefit is often accompanied by unacceptable adverse effects. Dopaminomimetics are the most satisfactory medications, including levodopa and such artificial dopamine agonists as bromocriptine, pergolide, or lisuride.