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Education And Debate

Fortnightly Review: Drug treatment of Parkinson's disease

BMJ 1995; 310 doi: (Published 04 March 1995) Cite this as: BMJ 1995;310:575
  1. Niall Quinn, reader in clinical neurologya
  1. a Institute of Neurology, National Hospital for Neurology and Neurosurgery, London WC1N 3BG
  2. The address of the Parkinson's Disease Society is 22 Upper Woburn Place, London WC1H 0RA (tel 0171 383 3513).


    Summary points

    • A wide variety of drugs is available for treating Parkinson's disease, including anticholinergics, amantadine levodopa, dopamine agonists, and selegeline

    • In younger patients (<50) levodopa is usually delayed provided that adequate relief of symptoms can be achieved with other drugs. In older patients (>70) levodopa should be started as soon as symptom relief is required. Between these ages there is no consensus, but at present most such patients should probably be given controlled release levodopa before a dopamine agonist is added

    • Fluctuations can often be alleviated by giving controlled release preparations of levodopa, by giving small doses at frequent intervals, by adding selegiline or a long acting oral agonist, or by subcutaneous apomorphine

    • Dyskinesia can be peak dose, diphasic, or “off period.” The diphasic form is hardest to alleviate

    • Psychiatric side effects should initially be managed by changing the antiparkinsonian treatment before resorting to antipsychotic drugs

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