Management of Parkinson's disease - A review of current and new therapies

The management of Parkinson's disease has undergone recent changes with the advent of new therapies, both pharmacotherapy and surgery. Available inter ventions are discussed. Levodopa remains the mainstay of therapy. New drugs include the dopamine agonists and COMT inhibitors. New dopamine agonists w hich may have a levodopa "sparing effect;" it has been suggested that some of the drugs should be considered as first line treatments for newly diagno sed Parkinson's disease patients. We review roles of these drugs. The conce pt of neuroprotection in neurodegenerative disorders such as Parkinson's di sease became popular in the mid 1980s and it is hoped that eventually thera py will be directed at slowing progression of the disease. A great deal mor e work needs to be done before a suitable agent is identified as being neur oprotective. Potential neuroprotective agents are reviewed. Surgical therap ies for Parkinson's disease consisting of various forms of lesion surgery a s well as stimulation procedures are reviewed. Complications of drug therap y include motor problems such as motor response fluctuations, as well as ps ychiatric complications including levodopa-induced psychosis, Atypical neur oleptic agents and ECT fur psychiatric syndromes associated with Parkinson' s disease are discussed. Algorithms for the management of early disease as well as the management of psychosis in Parkinson's disease are included. Tr eatment options for advanced disease are tabulated.