Abstract
Parkinson`s disease (PD) is a progressive, disabling neurodegenerative disorder with onset of motor and non-motor features. Both reduce quality of life of PD patients and cause caregiver burden. This review aims to provide a survey of possible therapeutic options for treatment of motor and non motor symptoms of PD and to discuss their relation to each other. MAO-B-Inhibitors, NMDA antagonists, dopamine agonists and levodopa with its various application modes mainly improve the dopamine associated motor symptoms in PD. This armentarium of PD drugs only partially influences the onset and occurrence of non motor symptoms. These PD features predominantly result from non dopaminergic neurodegeneration. Autonomic features, such as seborrhea, hyperhidrosis, orthostatic syndrome, salivation, bladder dysfunction, gastrointestinal disturbances, and neuropsychiatric symptoms, such as depression, sleep disorders, psychosis, cognitive dysfunction with impaired execution and impulse control may appear. Drug therapy of these non motor symptoms complicates long-term PD drug therapy due to possible occurrence of drug interactions, - side effects, and altered pharmacokinetic behaviour of applied compounds. Dopamine substituting compounds themselves may contribute to onset of these non motor symptoms. This complicates the differentiation from the disease process itself and influences therapeutic options, which are often limited because of additional morbidity with necessary concomitant drug therapy.
Highlights
Parkinsons disease (PD) is a progressive, disabling neurodegenerative disorder
Treatment of motor symptoms Mainly akinesia, rigidity and clinical associated features and to a lesser extent tremor respond to dopaminergic stimulation in PD patients
Therapy recommendations for PD patients only based on the so-called evidence based medicine, which overemphasizes the value of clinical randomized placebo controlled studies according the guidelines of good clinical practice with its selected patient populations, are somewhat “foolish” and beyond reality in clinical practice [57]
Summary
Treatment of motor symptoms Mainly akinesia, rigidity and clinical associated features and to a lesser extent tremor respond to dopaminergic stimulation in PD patients. Continuous introduodenal LD/DDI treatment Initially LD is well tolerated and provides no MC This is called the honeymoon period of LD therapy, followed by the insidious onset of MC and associated non motor features, when the drug efficacy vanes. Pharmacokinetic and clinical trials on the effects of repeat COMT intake showed, that the addition of COMT-inhibitors increases peak levels and the amount of plasma LD, which is delivered to the brain Impulse control disorders, like pathological gambling, compulsive shopping, binge eating, punding and hypersexuality, are observed These changes are especially seen in PD patients with young age of onset, higher dosing of dopamine substituting compounds, depression, recreational drug or alcohol abuse, and high novelty seeking personality traits. Trials are ongoing [62]
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
