[Clinical aspects and conservative therapy of Parkinson disease]

Parkinson's disease is essentially motor. The core symptoms comprise akinesia, rigidity and tremor. Concomitantly, signs of autonomic, cognitive and affective disturbances may be found. The disease progresses slowly and, without treatment, ultimately results in disability and loss of independence. The symptoms can be controlled for a long time by pharmacotherapy. Dopaminergic drugs such as L-DOPA, dopaminreceptor agonists, and MAO-B- and COMT-blockers can essentially improve most of the symptoms. The tremor may be alleviated by central anticholinergic drugs. With time, however, unwanted side effects such as "end of dose akinesia", "on-off phenomena", hyperkinesis and exogenous psychosis come into play. Therefore, pharmacological treatment becomes very complex in the late stages of the disease and the unwanted side effects can no longer be sufficiently controlled. It is not clear whether conservative approaches will be ever able to cope with these problems. This explains the search for novel treatment strategies, e.g. neurotransplantation, stereotaxic lesion of the subthalamic nucleus or stimulation techniques.