Learn All About The Treatment of Parkinson's disease - By: Thomas H. Lindblom

Parkinson's disease (PD) is a chronic, progressive, neurodegenerative disorder. It is estimated that more than 1 percent of the population over age 65 are afflicted with PD; incidence and prevalence increase with age. There us an estimated prevalence of 31 to 328 per 100,000 people worldwide.

PD is caused by idiopathic degeneration of dopamine-producing cells in the substantia nigra, located in the midbrain. Three "cardinal signs" of PD are resting tremor, cogwheel rigidity, and bradykinesia. The fourth cardinal sign in PD is postural instability, typically a late finding. Additional common findings are asymmetrical onset of symptoms and symptomatic response to L-dopa (levodopa). Diagnosis of PD is problematic because of the lack of a reference standard test. The diagnosis is generally made clinically, although up to 25 percent of patients with clinical diagnoses of PD have received different pathological diagnoses at autopsy.

L-dopa is the keystone of pharmacological treatment for PD; however, its use is limited by the development of motor fluctuations and drug-induced dyskinesias. Dopamine agonists (DAs) are also used, either alone or in combination with L-dopa. DAs act directly on dopamine receptors, simulating endogenous dopamine. Monoamine oxidase B (MAO-B) inhibitors act by inhibiting dopamine catabolism, increasing dopamine levels in the basal ganglia.

In patients with early PD, the task of treatment is to alleviate symptoms and maintain independent function. In advanced PD, the focus is aimed toward maximizing on time, minimizing off time, and treating medication-related complications, such as dyskinesias, motor fluctuations, and psychiatric problems.

Surgical treatment for PD is generally considered for patients who respond to medications but have intolerable side effects. Surgical options include ablative procedures (pallidotomy or thalamotomy), deep brain stimulation, and tissue transplantation.
There are numerous unanswered questions regarding the diagnosis and management of PD. MetaWorks investigators developed an evidence base through a systematic review of the English-language literature from 1990 to 2000 pertinent to patients with PD. This synthesis of the best available and most recent evidence is intended to serve as an information resource for decision makers and developers of practice guidelines and recommendations. It also should serve to highlight gaps in the literature and areas that require future research.

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