Fast Five Quiz: Management of Parkinson's Disease

Rajesh Pahwa, MD


January 13, 2022

Although levodopa is the preferred initial dopaminergic therapy for the majority of patients in managing motor symptoms in early disease, higher doses are more likely to cause dyskinesia. In patients with early Parkinson's disease, the lowest effective dose should be prescribed to minimize the chances of developing dyskinesia and other side effects. Patients should be counseled on these risks when making treatment decisions. In patients younger than 60 years with high risk for dyskinesia, dopamine agonists may be used.

Treatment should be initiated when symptoms begin to cause physical or social disability and decrease quality of life. Although a wait-and-watch approach may be employed, delaying therapy is not associated with worse outcomes, as was theorized in the past.

While it is likely that various clinical phenotypes reflect divergent underlying mechanisms (which may respond differently to therapy), criteria to identify clinical subtypes have not yet been validated for Parkinson's disease, though patients may be classified by genetic profile. In most populations, 10%-15% of cases are linked to known Parkinson's disease genes, representing monogenic Parkinson's disease. Disease-modifying therapy is the focus of future research.

Learn more about what to consider in the treatment approach for Parkinson's disease.


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