Recent Research Progress in and Future Perspective on Treatment of Parkinson's Disease

Background: Clinical features, pathogenesis, and treatment of Parkinson's disease (PD) are reviewed as there has been progress in these areas. Summary: PD is a systemic disease of the nervous system as the initial symptom is related to disturbance of the autonomic nervous system, such as constipation or nocturia. Then, the disease progresses to the brain stem involving the nuclei in the pons and the substantia nigra, and inducing sleep and wakefulness disturbances, affect problems such as anxiety and depression, and motor problems when the disease process has reached the substantia nigra. Furthermore, the disease has an effect on the nucleus basalis of Meynert, the amygdaloid complex and the cerebrum manifesting cognitive impairment. The olfactory pathway is also frequently involved. Key Messages: For the treatment of PD, younger patients without dementia should be treated with a nonergot dopamine agonist first and then with levodopa if necessary. Elderly patients or those with dementia should be treated with levodopa. However, after 5 years of levodopa treatment, many patients with PD develop wearing off. Drugs for the treatment of wearing-off symptoms are reviewed. Many of the patients with wearing-off symptoms develop dyskinesia, and amantadine is so far the only drug that can ameliorate dyskinesia. Because of this situation, a new method of treatment is warranted, such as RNA interaction, according to the author's opinion. Recent progress in this field is also reviewed. i 2014 S. Karger AG, Basel