Parkinson's diseasetherapy: treatment of early and late disease

Purpose To summarize the current strategies for the treatment of early and late Parkinson's disease (PD). Data sources The presented guidelines are based on the review of the litera ture as well as the author's extensive experience with the treatment of 700 0 patients with PD over the past 25 years. Results An analysis of reported data as well as personal experience suggest that while young patients seem to have a slower progression of the disease , they are at a higher risk for developing levodopa induced complications, such as motor fluctuations and dyskinesias. It is, therefore, prudent pract ice to delay levodopa therapy, particularly in younger patients, until the PD symptoms become troublesome and interfere with social or occupational fu nctioning. Other strategies, such as the use of deprenyl, amantadine, trihe xyphenidyl and dopamine agonists, should be employed before instituting lev odopa therapy. Entacopone and dopamine agonists are useful in smoothing out levodopa related motor fluctuations. Surgical interventions, such as palli dotomy and pallidal or subthalamic deep brain stimulation, are effective th erapeutic strategies, but should be reserved only for patients in whom opti mal medical therapy fails to provide satisfactory control of symptoms. Conclusion The medical and surgical treatment of patients with PD must be i ndividualized and tailored to the needs of the individual patient.