Optimal Treatment in Parkinson’s Disease: Pharmacotherapy and Practical Tips

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Kongkiat Kulkantrakorn, MD


Parkinson’s disease, a common neurodegenerative disorder, is treatable. The currenttreatment strategy is focused on dopamine replacement. Every patient will eventuallyreceive levodopa which is the gold standard therapy, but it is associated with motorcomplication in a later phase. Using other dopaminergic medications as the fi rst linetreatment to avoid levodopa usage may reduce motor complication, but they are lesseffi cacious in symptomatic control. However, in the later stage of the disease, patientsoften need other medications to optimize dopaminergic transmission. Dopamine agonist(DA), monoamine oxidase inhibitor (MAO-BI) and catechol-o-methyl-transferaseinhibitors (COMTI) are standard adjunctive medications in patients who have levodopa-induced motor complication.


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Kulkantrakorn K. Optimal Treatment in Parkinson’s Disease: Pharmacotherapy and Practical Tips. BKK Med J [Internet]. 2015Sep.18 [cited 2020Jul.15];10(1):59. Available from: https://he02.tci-thaijo.org/index.php/bkkmedj/article/view/221138
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1. Hughes AJ, Daniel SE, Kilford L, et al. Accuracy of clinical diagnosis of idiopathic Parkinson’s disease: a clinico-pathological study of 100 cases. J Neurol Neurosurg Psychiatry 1992;55:181-4.
2. Connolly BS, Lang AE. Pharmacological treatment of Parkinson’s disease: a review. JAMA 2014;311:1670-83.
3. Stacy MA, Murck H, Kroenke K. Responsiveness of motor and non-motor symptoms of Parkinson’s disease to dopaminergic therapy. Prog Neuropsychopharmacol Biol Psychiatry 2010;34:57-61.
4. Pont-Sunyer C, Hotter A, Gaig C, et al. The onset of non-motor symptoms in Parkinson’s disease (the ONSET PD study). Mov Disord 2015;30:229-37.
5. Berg D, Lang AE, Postuma RB, et al. Changing the research criteria for the diagnosis of Parkinson’s disease: obstacles and opportunities. Lancet Neurol 2013;12:514-24.
6. Lang AE. In pursuit of prodromal Parkinson’s disease. Lancet Neurol 2015;14:27-8.
7. Braak H, Del Tredici K, Rub U, et al. Staging of brain pathology related to sporadic Parkinson’s disease. Neurobiol Aging 2003;24:197-211.
8. Kulkantrakorn K, Tiamkao S, Pongchaiyakul C, et al. Levodopa-induced motor complications in Thai Parkinson’s disease patients. J Med Assoc Thai 2006;89:632-7.
9. Cilia R, Akpalu A, Sarfo FS, et al. The modern prelevodopa era of Parkinson’s disease: insights into motor complications from sub-Saharan Africa. Brain 2014; 137:2731-42.
10. Fahn S. Levodopa in the treatment of Parkinson’s disease. J Neural Transm Suppl 2006:1-15.
11. Stocchi F, Rascol O, Kieburtz K, et al. Initiating levodopa/ carbidopa therapy with and without entacapone in early Parkinson’s disease: the STRIDE-PD study. Ann Neurol 2010;68:18-27.
12. Warren Olanow C, Kieburtz K, Rascol O, et al. Factors predictive of the development of Levodopa-induced dyskinesia and wearing-off in Parkinson’s disease. Mov Disord 2013;28:1064-71.
13. Lang AE, Marras C. Initiating dopaminergic treatment in Parkinson’s disease. Lancet 2014;384:1164-6.
14. Chondrogiorgi M, Tatsioni A, Reichmann H, et al. Dopamine agonist monotherapy in Parkinson’s disease and potential risk factors for dyskinesia: a meta-analysis of levodopa-controlled trials. Eur J Neurol 2014;21:433-40.
15. Barone P, Poewe W, Albrecht S, et al. Pramipexole for the treatment of depressive symptoms in patients with Parkinson’s disease: a randomised, double-blind, placebocontrolled trial. Lancet Neurol 2010;9:573-80.
16. Stowe R, Ives N, Clarke CE, et al. Evaluation of the efficacy and safety of adjuvant treatment to levodopa therapy in Parkinson’s disease patients with motor complications. Cochrane database of systematic reviews 2010:CD007166.
17. Garcia-Ruiz PJ, Martinez Castrillo JC, Alonso-Canovas A, et al. Impulse control disorder in patients with Parkinson’s disease under dopamine agonist therapy: a multicentre study. J Neurol Neurosurg Psychiatry 2014;85:840-4.
18. Villa C, Pascual-Sedano B, Pagonabarraga J, et al. Impulse control disorders and dopaminergic treatments in Parkinson’s disease. Rev Neurol (Paris) 2011;167:827-32.
19. Voon V, Sohr M, Lang AE, et al. Impulse control disorders in Parkinson’s disease: a multicenter casecontrol study. Ann Neurol 2011;69:986-96.
20. Wood LD. Clinical review and treatment of select adverse effects of dopamine receptor agonists in Parkinson’s disease. Drugs Aging 2010;27:295-310.
21. Rascol O, Brooks DJ, Melamed E, et al. Rasagiline as an adjunct to levodopa in patients with Parkinson’s disease and motor fluctuations (LARGO, Lasting effect in Adjunct therapy with Rasagiline Given Once daily, study): a randomised, double-blind, parallel-group trial. Lancet 2005;365:947-54.
22. Rascol O, Fitzer-Attas CJ, Hauser R, et al. A doubleblind, delayed-start trial of rasagiline in Parkinson’s disease (the ADAGIO study): prespecified and posthoc analyses of the need for additional therapies, changes in UPDRS scores, and non-motor outcomes. Lancet Neurol 2011;10:415-23.
23. Tolosa E, Stern MB. Efficacy, safety and tolerability of rasagiline as adjunctive therapy in elderly patients with Parkinson’s disease. Eur J Neurol 2012;19:258-64.
24. Perez-Lloret S, Rascol O. Safety of rasagiline for the treatment of Parkinson’s disease. Expert Opin Drug Saf 2011;10:633-43.
25. Schrag A. Entacapone in the treatment of Parkinson’s disease. Lancet Neurol 2005;4:366-70.
26. Ferreira JJ, Katzenschlager R, Bloem BR, et al. Summary of the recommendations of the EFNS/MDS-ES review on therapeutic management of Parkinson’s disease. Eur J Neurol 2013;20:5-15.
27. Grimes D, Gordon J, Snelgrove B, et al. Canadian Guidelines on Parkinson’s Disease. Can J Neurol Sci 2012;39: S1-30.
28. Group PDMC, Gray R, Ives N, et al. Long-term effectiveness of dopamine agonists and monoamine oxidase B inhibitors compared with levodopa as initial treatment for Parkinson’s disease (PD MED): a large, open-label, pragmatic randomised trial. Lancet 2014;384:1196-205.
29. Schapira AH, McDermott MP, Barone P, et al. Pramipexole in patients with early Parkinson’s disease (PROUD): a randomised delayed-start trial. Lancet Neurol 2013; 12:747-55.
30. Hauser RA, Hsu A, Kell S, et al. Extended-release carbidopa- levodopa (IPX066) compared with immediaterelease carbidopa-levodopa in patients with Parkinson’s disease and motor fluctuations: a phase 3 randomised, double-blind trial. Lancet Neurol 2013;12:346-56.
31. Stowe R, Ives N, Clarke CE, et al. Meta-analysis of the comparative efficacy and safety of adjuvant treatment to levodopa in later Parkinson’s disease. Mov Disord 2011;26:587-98.
32. Fox SH, Katzenschlager R, Lim SY, et al. The Movement Disorder Society Evidence-Based Medicine Review Update: Treatments for the motor symptoms of Parkinson’s disease. Mov Disord 2011;26:S2-41.