Medical and surgical treatment of Parkinson's disease. Strategies to slow symptom progression and improve quality of life.

Despite new medical and surgical therapy, mortality rates for Parkinson's disease remain unchanged. Nevertheless, symptom progression can be slowed and quality of life improved with current methods of treatment. Levodopa is the most effective drug for Parkinson's disease, but its long-term use is associated with significant motor complications. Dopamine agonists hold promise because of more sustained stimulation of dopamine receptors and possibly an antioxidant effect. Selegiline, amantadine, and anticholinergics are still used but must be employed with caution in the elderly. COMT inhibitors may be useful adjuncts to levodopa therapy but are plagued with serious adverse effects. Goals of therapy in patients less than 60 years of age include sparing levodopa therapy and providing neuroprotection. For patients 60 years and older, goals include maintaining cognitive status and treating symptoms. Surgical treatment includes globus pallidus internal-segment pallidotomy, deep brain stimulation, and fetal nigral transplantation. These hold promise for the future.