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Treatment of Early Parkinson's Disease

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Treatment of Early Parkinson's Disease

Abstract and Introduction

Abstract


Purpose of Review. This review summarizes currently available treatment options and treatment strategies, investigational treatments, and the importance of exercise for early Parkinson's disease.

Recent Findings. The available treatment options for early Parkinson's disease have changed little in the past decade and include carbidopa/levodopa, dopamine agonists, and monoamine oxidase type B (MAO-B) inhibitors. However, we discuss changes in treatment strategies, including dosing and the use of combination therapy used in an attempt to reduce or delay the appearance of motor complications and other adverse events. We will also review several investigational treatments that have shown promise for the treatment of early Parkinson's disease, including a new extended release formulation of carbidopa/levodopa (IPX066), safinamide which inhibits MAO-B, dopamine uptake and glutamate and pardoprunox which is a 5HT-1A agonist and a partial dopamine agonist. Finally, we discuss recent studies focusing on exercise as an important component in the management of early Parkinson's disease.

Summary. Advances in the management of early Parkinson's disease include evolving treatment strategies, new investigational treatments, and earlier implementation of various forms of exercise.

Introduction


Parkinson's disease affects an estimated one million persons in the United States, with over five million affected worldwide, and these estimates are expected to increase substantially in the next few decades. Despite the increasing prevalence, the approved agents for the early management of Parkinson's disease have changed little in the past decade; however, there have been advances in drug delivery, dosing, and the use of combination therapy in an attempt to reduce adverse events. The available treatments continue to focus on the dopaminergic system and include primarily carbidopa/levodopa, monoamine oxidase type B (MAO-B) inhibitors, and dopamine agonists. Current research on the early management of Parkinson's disease focuses on improved and more consistent drug delivery systems, targeting alternate neurotransmitter systems and the identification of neuroprotective therapies for Parkinson's disease. There has also been an increased interest in earlier intervention with various forms of exercise in addition to pharmacological treatments. This article includes a review of the available treatment options for early Parkinson's disease, published trials of new pharmacological treatments under investigation for the symptomatic treatment of early Parkinson's disease, and the potential benefits of exercise in early Parkinson's disease.

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