International Parkinson and movement disorder society evidence‐based medicine review: Update on treatments for the motor symptoms of Parkinson's disease

ABSTRACT Objective: The objective of this review was to update evidence‐based medicine recommendations for treating motor symptoms of Parkinson's disease (PD). Background: The Movement Disorder Society Evidence‐Based Medicine Committee recommendations for treatments of PD were first published i...

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Published in:Movement disorders Vol. 33; no. 8; pp. 1248 - 1266
Main Authors: Fox, Susan H., Katzenschlager, Regina, Lim, Shen‐Yang, Barton, Brandon, de Bie, Rob M. A., Seppi, Klaus, Coelho, Miguel, Sampaio, Cristina
Format: Journal Article
Language:English
Published: United States 01.08.2018
Subjects:
amantadine
anticholinergics
Antiparkinson Agents
catechol‐O‐methyl transferase inhibitors
clozapine
complementary therapies
Deep Brain Stimulation
dopamine agonists
Evidence-Based Medicine
exercise
Humans
International Cooperation
levodopa
monoamine oxidase inhibitors
neurosurgery
occupational therapy
Parkinson Disease - physiopathology
Parkinson Disease - therapy
Parkinson's disease
physical therapy
Physical Therapy Modalities
randomized controlled trial
Societies, Scientific - standards
speech therapy
Parkinson's disease
monoamine oxidase inhibitors
speech therapy
catechol-O-methyl transferase inhibitors
exercise
amantadine
dopamine agonists
deep brain stimulation
randomized controlled trial
complementary therapies
levodopa
clozapine
physical therapy
neurosurgery
anticholinergics
evidence-based medicine
occupational therapy
ISSN:0885-3185, 1531-8257, 1531-8257
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Summary:ABSTRACT Objective: The objective of this review was to update evidence‐based medicine recommendations for treating motor symptoms of Parkinson's disease (PD). Background: The Movement Disorder Society Evidence‐Based Medicine Committee recommendations for treatments of PD were first published in 2002 and updated in 2011, and we continued the review to December 31, 2016. Methods: Level I studies of interventions for motor symptoms were reviewed. Criteria for inclusion and quality scoring were as previously reported. Five clinical indications were considered, and conclusions regarding the implications for clinical practice are reported. Results: A total of 143 new studies qualified. There are no clinically useful interventions to prevent/delay disease progression. For monotherapy of early PD, nonergot dopamine agonists, oral levodopa preparations, selegiline, and rasagiline are clinically useful. For adjunct therapy in early/stable PD, nonergot dopamine agonists, rasagiline, and zonisamide are clinically useful. For adjunct therapy in optimized PD for general or specific motor symptoms including gait, rivastigmine is possibly useful and physiotherapy is clinically useful; exercise‐based movement strategy training and formalized patterned exercises are possibly useful. There are no new studies and no changes in the conclusions for the prevention/delay of motor complications. For treating motor fluctuations, most nonergot dopamine agonists, pergolide, levodopa ER, levodopa intestinal infusion, entacapone, opicapone, rasagiline, zonisamide, safinamide, and bilateral STN and GPi DBS are clinically useful. For dyskinesia, amantadine, clozapine, and bilateral STN DBS and GPi DBS are clinically useful. Conclusions: The options for treating PD symptoms continues to expand. These recommendations allow the treating physician to determine which intervention to recommend to an individual patient. © 2018 International Parkinson and Movement Disorder Society
Bibliography:Nothing to report.
Relevant conflicts of interests/financial disclosures
ObjectType-Article-1
SourceType-Scholarly Journals-1
ObjectType-Feature-2
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ISSN:0885-3185
1531-8257
1531-8257
DOI:10.1002/mds.27372