Amantadine Revisited: A Contender for Initial Treatment in Parkinson's Disease?

Abstract

The best practice for the initiation of symptomatic motor treatment for Parkinson's diseaseis an ongoing topic of debate. Fueled by interpretation of the results of the LEAP and MED Parkinson's diseasestudies, many practitioners opt for early initiation of levodopa formulations, avoiding dopamine agonists to circumvent potentialdeleteriousside effects, namely impulse control disorder. Compared with levodopa,monoamine oxidase inhibitors may lack necessarypotency. Ignored in this academic debate is another therapeutic optionfor patients withParkinson's diseaserequiring treatment initiation: amantadine. Amantadine was first reported effective in the treatment ofParkinson's diseasein1969 and several studies were published in the 1970s supporting its efficacy. Currently, amantadine is mainly utilizedas an add-on therapy to mitigate levodopa-related dyskinesia and, more recently, new long-acting amantadine formulations have been developed,withnewindications to treat motor fluctuations. Amantadine has not been reported to cause dyskinesia and is rarely implicated in impulse control disorder.