Neurological Clinic Research Unit, Institute of Molecular Medicine, Lisbon School of Medicine, Lisbon, Portugal
Parkinson’s disease is a common neurodegenerative disorder with the particular feature of having various available treatments with proven efficacy. However, no treatment is curative. Recent trial results provided data for the discussion about the potential disease-modifying effect of new drugs as well as of other therapeutic strategies. The changing clinical phenotype following the progression of the disease multiplies the number of treatment targets and makes the application of recommendations from guidelines or other treatment algorithms to the individual patient a complex task.
A 70-year-old male farmer was referred to a movement disorders outpatient clinic due to a 1-year nondisabling intermittent resting tremor of the left hand, that later progressed to the contralateral hand. On neurological examination the patient had normal cognition. Myerson sign was present. Oculomotor examination was normal. An intermittent mild resting tremor was observed in the left hand, as well as mild signs of asymmetrical cogwheel rigidity and bradykinesia (left > right). Gait and balance were normal as well as postural reflexes.
Which treatment options should be considered to initiate treatment? In early-stage disease, the pharmacological options for the treatment of PD are multiple. These range from not initiating treatment (e.g. just scheduling a later visit) to starting treatment with one of the available efficacious symptomatic drugs: immediate-release (IR) levodopa, controlled-release (CR) levodopa, levodopa plus entacapone, dopamine agonists (immediate release.
Falls represent an important cause of significant morbidity and dependence in PD [Schrage et al. 2006]. To approach this problem properly, there is a need to rigorously characterize the presented phenomenology. For this patient, it is crucial to determine the time of occurrence of falls, putative.
Recommendations for the treatment of early Parkinson’s disease. Only the highest level of recommendation available is provided.
| Recommendations | Therapeutic target | ||
| Prevention of clinical progression | Symptomatic control of parkinsonism | Prevention of motor complications | |
| MDS | Insufficient data | Levodopa, levodopa CR, pergolide, pramipexole, ropinirole, DHEC, | Cabergoline, ropinirole, pramipexole |
| NICE | No drug recommended | Levodopa, none got dopamine agonists, MAO-I | No Data |
PD is a neurodegenerative movement disorder with a long duration and changing phenomenology that makes its management challenging, even in the strict motor perspective. During its course, different clinical problems emerge as potential therapeutic goals. Applying the available evidence concerning treatment options in PD to the individual patient is the key to a successful management of patients. In early PD, multiple options exist ranging from no treatment to different.
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