Juan C Giugni1, Michael S Okun. 1. Departments of Neurology and Neurosurgery, University of Florida Center for Movement Disorders and Neurorestoration, Gainesville, Florida, USA.
Abstract
PURPOSE OF REVIEW: Later stage Parkinson's disease, sometimes referred to as advanced disease, has been characterized by motor complication, as well as by the potential emergence of nonlevodopa responsive motor and nonmotor symptoms. The management of advanced stage Parkinson's disease can be complex. This review summarizes the currently available treatment strategies for addressing advanced Parkinson's disease. RECENT FINDINGS: We will discuss the latest pharmacological strategies (e.g., inhibitors of dopamine-metabolizing enzymes, dopamine agonists, and extended release dopamine formulations) for addressing motor dysfunction. We will summarize the risks and benefits of current invasive treatments. Finally, we will address the current evidence supporting the treatment of nonmotor symptoms in the advanced Parkinson's disease patient. We will conclude by detailing the potential nonpharmacological and multidisciplinary approaches for advanced stage Parkinson's disease. SUMMARY: The optimization of levodopa is, in most cases, the most powerful therapeutic option available; however, medication optimization requires an advanced understanding of Parkinson's disease. Failure of conventional pharmacotherapy should precipitate a discussion of the potential risks and benefits of more invasive treatments. Currently, there are no comparative studies of invasive treatment. Among the invasive treatments, deep brain stimulation has the largest amount of existing evidence, but also has the highest individual per patient risk. Nonmotor symptoms will affect quality of life more than the motor Parkinson's disease symptoms, and these nonmotor symptoms should be aggressively treated. Many advanced Parkinson's disease patients will likely benefit from multi and interdisciplinary Parkinson's disease teams with multiple professionals collaborating to develop a collective and tailored strategy for an individual patient.
PURPOSE OF REVIEW: Later stage Parkinson's disease, sometimes referred to as advanced disease, has been characterized by motor complication, as well as by the potential emergence of nonlevodopa responsive motor and nonmotor symptoms. The management of advanced stage Parkinson's disease can be complex. This review summarizes the currently available treatment strategies for addressing advanced Parkinson's disease. RECENT FINDINGS: We will discuss the latest pharmacological strategies (e.g., inhibitors of dopamine-metabolizing enzymes, dopamine agonists, and extended release dopamine formulations) for addressing motor dysfunction. We will summarize the risks and benefits of current invasive treatments. Finally, we will address the current evidence supporting the treatment of nonmotor symptoms in the advanced Parkinson's diseasepatient. We will conclude by detailing the potential nonpharmacological and multidisciplinary approaches for advanced stage Parkinson's disease. SUMMARY: The optimization of levodopa is, in most cases, the most powerful therapeutic option available; however, medication optimization requires an advanced understanding of Parkinson's disease. Failure of conventional pharmacotherapy should precipitate a discussion of the potential risks and benefits of more invasive treatments. Currently, there are no comparative studies of invasive treatment. Among the invasive treatments, deep brain stimulation has the largest amount of existing evidence, but also has the highest individual per patient risk. Nonmotor symptoms will affect quality of life more than the motor Parkinson's disease symptoms, and these nonmotor symptoms should be aggressively treated. Many advanced Parkinson's diseasepatients will likely benefit from multi and interdisciplinary Parkinson's disease teams with multiple professionals collaborating to develop a collective and tailored strategy for an individual patient.
Authors: Susan H Fox; Regina Katzenschlager; Shen-Yang Lim; Bernard Ravina; Klaus Seppi; Miguel Coelho; Werner Poewe; Olivier Rascol; Christopher G Goetz; Cristina Sampaio Journal: Mov Disord Date: 2011-10 Impact factor: 10.338
Authors: M Péchevis; C E Clarke; P Vieregge; B Khoshnood; C Deschaseaux-Voinet; G Berdeaux; M Ziegler Journal: Eur J Neurol Date: 2005-12 Impact factor: 6.089
Authors: Marios Politis; Kit Wu; Sophie Molloy; Peter G Bain; K Ray Chaudhuri; Paola Piccini Journal: Mov Disord Date: 2010-08-15 Impact factor: 10.338
Authors: Kenneth A Follett; Frances M Weaver; Matthew Stern; Kwan Hur; Crystal L Harris; Ping Luo; William J Marks; Johannes Rothlind; Oren Sagher; Claudia Moy; Rajesh Pahwa; Kim Burchiel; Penelope Hogarth; Eugene C Lai; John E Duda; Kathryn Holloway; Ali Samii; Stacy Horn; Jeff M Bronstein; Gatana Stoner; Philip A Starr; Richard Simpson; Gordon Baltuch; Antonio De Salles; Grant D Huang; Domenic J Reda Journal: N Engl J Med Date: 2010-06-03 Impact factor: 91.245
Authors: Murat Emre; Werner Poewe; Peter Paul De Deyn; Paolo Barone; Jaime Kulisevsky; Emmanuelle Pourcher; Teus van Laar; Alexander Storch; Federico Micheli; David Burn; Frank Durif; Rajesh Pahwa; Francesca Callegari; Nadia Tenenbaum; Christine Strohmaier Journal: Clin Neuropharmacol Date: 2014 Jan-Feb Impact factor: 1.592
Authors: Colleen M Niswender; Carrie K Jones; Xin Lin; Michael Bubser; Analisa Thompson Gray; Anna L Blobaum; Darren W Engers; Alice L Rodriguez; Matthew T Loch; J Scott Daniels; Craig W Lindsley; Corey R Hopkins; Jonathan A Javitch; P Jeffrey Conn Journal: ACS Chem Neurosci Date: 2016-08-05 Impact factor: 4.418