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Management of Parkinson's Disease: A Review of Current and New Therapies

  • Tilak Mendis (a1), Oksana Suchowersky (a2), Anthony Lang (a3) and Serge Gauthier (a4)

Abstract:

The management of Parkinson's disease has undergone recent changes with the advent of new therapies, both pharmacotherapy and surgery. Available interventions are discussed. Levodopa remains the mainstay of therapy. New drugs include the dopamine agonists and COMT inhibitors. New dopamine agonists which may have a levodopa “sparing effect;” it has been suggested that some of the drugs should be considered as first line treatments for newly diagnosed Parkinson's disease patients. We review roles of these drugs. The concept of neuroprotection in neurodegenerative disorders such as Parkinson's disease became popular in the mid 1980s and it is hoped that eventually therapy will be directed at slowing progression of the disease. A great deal more work needs to be done before a suitable agent is identified as being neuroprotective. Potential neuroprotective agents are reviewed. Surgical therapies for Parkinson's disease consisting of various forms of lesion surgery as well as stimulation procedures are reviewed. Complications of drug therapy include motor problems such as motor response fluctuations, as well as psychiatric complications including levodopa-induced psychosis. Atypical neuroleptic agents and ECT for psychiatric syndromes associated with Parkinson's disease are discussed. Algorithms for the management of early disease as well as the management of psychosis in Parkinson's disease are included. Treatment options for advanced disease are tabulated.

Résumé:

Le traitement de la maladie de Parkinson a subi plusieurs changements récemment avec l'arrivée de nouvelles options thérapeutiques tant pharmacologiques que chirurgicales. Dans cet article, nous discutons des modes de traitement qui sont disponibles actuellement. La lévodopa demeure la pierre angulaire du traitement de la maladie de Parkinson. Cependant, plusieurs agents pharmacologiques nouveaux ont été développés, dont les agonistes de la dopamine et les inhibiteurs de la COMT. Avec la venue de nouveaux agonistes de la dopamine qui pourraient avoir un effet d'épargne de la lévodopa, on a suggéré que certains médicaments devraient être considérés comme traitement de première ligne chez les patients dont le diagnostic est récent. Nous revoyons en détail le rôle de ces médicaments. Le concept de la neuroprotection dans les maladies neurodégénératives comme la maladie de Parkinson s'est popularisé au milieu des années 80 et on espère qu'éventuellement le traitement pourra ralentir la progression de la maladie. Il reste beaucoup de travail à faire avant qu'on puisse identifier un agent susceptible d'être neuroprotecteur dans la maladie de Parkinson. Dans cet article, nous revoyons les agents neuroprotecteurs potentiels. Il y a un regain d'intérêt pour les traitements chirurgicaux de la maladie de Parkinson et nous revoyons les différentes formes de traitements chirurgicaux par lésion ainsi que les procédures de stimulation. Les problèmes moteurs, tels les fluctuations de la réponse motrice, et les complications psychiatriques dont la psychose induite par la lévodopa, sont des complications du traitement médicamenteux. Nous revoyons plusieurs interventions utilisées dans ce contexte dont les agents neuroleptiques atypiques et les ETC, dans le contexte des syndromes psychiatriques associés à la maladie de Parkinson. Nous proposons des algorythmes pour le traitement de la maladie de Parkinson au début ainsi que pour la prise en charge de la psychose associée à cette maladie et nous présentons un inventaire des différentes options thérapeutiques dans la maladie de Parkinson en phase avancée. Il y a de plus en plus d'options thérapeutiques dans la maladie de Parkinson et le traitement de ses complications. Il existe des traitements pharmacologiques et chirurgicaux, et, pour la prise en charge des complications psychiatriques, des thérapies psychiatriques. Nous revoyons ces options dans cet article.

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Copyright

Corresponding author

Reprint requests to: Tilak Mendis, Elisabeth Bruyere Health Centre, 75 Bruyere Street, Ottawa, ON K1N 5C8

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Management of Parkinson's Disease: A Review of Current and New Therapies

  • Tilak Mendis (a1), Oksana Suchowersky (a2), Anthony Lang (a3) and Serge Gauthier (a4)

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