Neurology®
The most widely read and highly cited peer-reviewed Neurology journal
Quick Search
Advanced Search
This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Chinese Translation
Right arrow Correspondence:
Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when Correspondence are posted
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrowRequest Permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Lang, A. E.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Lang, A. E.
NEUROLOGY 2009;72:S39-S43
© 2009 American Academy of Neurology

When and how should treatment be started in Parkinson disease?

Anthony E. Lang, MD, FRCPC

From the Toronto Western Hospital and the University of Toronto, Canada.

Address correspondence and reprint requests to Anthony E. Lang, MD, FRCPC, Toronto Western Hospital and the University of Toronto, Canada lang{at}uhnres.utoronto.ca

The questions of when and how to start treatment for Parkinson disease (PD) remain extremely challenging. A variety of treatment- and patient-related factors must be taken into account when making these decisions. Ideally, neuroprotective therapy would be started at the time of diagnosis. However, no treatment has been unequivocally shown to modify disease progression, and those that have some evidence for this effect all provide confounding symptomatic benefits, which may also be important to supplement faltering compensatory mechanisms within the basal ganglia. Dopamine agonists are clearly associated with a reduction in the incidence of dyskinesias in the early years, but it is not certain that this translates into long-term benefit. In addition, a number of nonmotor side effects are more frequently associated with dopamine agonists than with levodopa. This review will highlight these and other issues that must be considered when deciding on the early treatment of PD.

Disclosure: The author has no financial conflicts related to this work.




This article has been cited by other articles:


Home page
 BMJHome page
D G Grosset, G J A Macphee, M Nairn, and on behalf of the Guideline Development Group
Diagnosis and pharmacological management of Parkinson's disease: summary of SIGN guidelines
BMJ, January 12, 2010; 340(jan12_2): b5614 - b5614.
[Full Text]