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Treatment of levodopa‐induced motor complications
Author(s) -
Stocchi Fabrizio,
Tagliati Michele,
Olanow C. Warren
Publication year - 2008
Publication title -
movement disorders
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.352
H-Index - 198
eISSN - 1531-8257
pISSN - 0885-3185
DOI - 10.1002/mds.22052
Subject(s) - levodopa , amantadine , dopaminergic , dopamine , medicine , parkinson's disease , deep brain stimulation , benserazide , parkinsonism , pharmacology , psychology , anesthesia , disease
Chronic levodopa treatment for Parkinson's disease patients is frequently associated with the development of motor complications such as end‐of‐dose wearing‐off and dyskinesias. In this review, we provide an overview of the strategies available for dealing with these problems. Medical management includes manipulation of levodopa dosing to establish the optimum treatment schedule, improving levodopa absorption, catechol‐ O ‐methyl transferase‐inhibition (COMT), Monoamine oxidase‐B (MAO‐B) inhibition, dopaminergic agonists, amantadine, and continuous dopaminergic infusions. Surgical procedures and particularly deep brain stimulation are also reviewed. It should be noted that none of these treatments has been shown to provide anti‐parkinsonian efficacy that is greater than what can be achieved with levodopa. We highlight the importance of initiating therapy with a treatment strategy that reduces the risk that a Parkinson's disease patient will develop motor complications in the first place. Key Words: Advanced PD, dyskinesias, motor fluctuations, levodopa, dopamine agonists, COMT inhibitors, MAO‐B inhibitors. © 2008 Movement Disorder Society