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The scientific and clinical basis for the treatment of Parkinson disease (2009)

From the Department of Neurology (C.W.O.), Department of Neuroscience (C.W.O.), and Bendheim Parkinson’s Disease Center (C.W.O.), Mount Sinai School of Medicine, New York, New York; Parkinson’s Disease and Movement Disorder Center (M.B.S), University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania; and Department of Neurology (K.S.), Division of Movement Disorders, Medical College of Georgia School of Medicine, Augusta, Georgia.

Address correspondence to Dr. C. Warren Olanow, Department of Neurology, Mount Sinai School of Medicine, 1 Gustave Levy Place, Annenberg 14-94 New York, NY 10029 warren.olanow{at}mssm.edu

Parkinson disease (PD) is an age-related neurodegenerative disorder that affects as many as 1–2% of persons aged 60 years and older. With the aging of the population, the frequency of PD is expected to increase dramatically in the coming decades. Current therapy is largely based on a dopamine replacement strategy, primarily using the dopamine precursor levodopa. However, chronic treatment is associated with the development of motor complications, and the disease is inexorably progressive. Further, advancing disease is associated with the emergence of features such as freezing, falling, and dementia which are not adequately controlled with dopaminergic therapies. Indeed, it is now appreciated that these nondopaminergic features are common and the major source of disability for patients with advanced disease. Many different therapeutic agents and treatment strategies have been evaluated over the past several years to try and address these unmet medical needs, and many promising approaches are currently being tested in the laboratory and in the clinic. As a result, there are now many new therapies and strategic approaches available for the treatment of the different stages of PD, with which the treating physician must be familiar in order to provide patients with optimal care. This monograph provides an overview of the management of PD patients, with an emphasis on pathophysiology, and the results of recent clinical trials. It is intended to provide physicians with an understanding of the different treatment options that are available for managing the different stages of the disease and the scientific rationale of the different approaches.

Supported by independent grants from Teva Neuroscience, Boehringer Ingelheim, Novartis/Orion, and Solvay Pharmaceuticals.

Disclosure: C.W.O. has served as a consultant for Boehringer Ingelheim, Teva, Novartis/Orion, Solvay, Merck-Serono, Ceregene, Eisai, Schering-Bayer and the welding defense. M.B.S. serves as a consultant for Boehringer Ingelheim, Novartis, Ipsen, and Teva. K.S. has served as a consultant for Novartis, GlaxoSmithKline, Boehringer Ingelheim, Schering Plough, Biogen, Teva, Solvay, Valeant, and Ipsen.

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