- Susan H. Fox MRCP (UK), PhD 1,2
- Regina Katzenschlager MD 3
- Shen‐Yang Lim MD, FRACP 4
- Bernard Ravina MD, MS 5
- Klaus Seppi MD 6
- Miguel Coelho MD 7
- Werner Poewe MD 6
- Olivier Rascol MD, PhD 8
- Christopher G. Goetz MD 9
- Cristina Sampaio MD, PhD 7
- Movement Disorder Clinic, Toronto Western Hospital, Toronto, Ontario, Canada
- Correspondence address: Movement Disorder Clinic, Toronto Western Hospital, 399, Bathurst St, Toronto, ON, Canada M5V 2S8
- Department of Neurology, Danube Hospital/SMZ‐Ost, Vienna, Austria
- Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- Department of Neurology, University of Rochester School of Medicine, Rochester, New York, USA
- Department of Neurology, University Hospital, Innsbruck, Austria
- Neurological Clinic Research Unit, Institute of Molecular Medicine, Lisbon School of Medicine, Lisbon, Portugal
- Department of Clinical Pharmacology, Toulouse University Hospital, Toulouse, France
- Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA
The objective was to update previous evidence‐based medicine reviews of treatments for motor symptoms of Parkinson's disease published between 2002 and 2005. Level I (randomized, controlled trial) reports of pharmacological, surgical, and nonpharmacological interventions for the motor symptoms of Parkinson's disease between January 2004 (2001 for nonpharmacological) and December 2010 were reviewed. Criteria for inclusion, clinical indications, ranking, efficacy conclusions, safety, and implications for clinical practice followed the original program outline and adhered to evidence‐based medicine methodology. Sixty‐eight new studies qualified for review. Piribedil, pramipexole, pramipexole extended release, ropinirole, rotigotine, cabergoline, and pergolide were all efficacious as symptomatic monotherapy; ropinirole prolonged release was likely efficacious. All were efficacious as a symptomatic adjunct except pramipexole extended release, for which there is insufficient evidence. For prevention/delay of motor fluctuations, pramipexole and cabergoline were efficacious, and for prevention/delay of dyskinesia, pramipexole, ropinirole, ropinirole prolonged release, and cabergoline were all efficacious, whereas pergolide was likely efficacious. Duodenal infusion of levodopa was likely efficacious in the treatment of motor complications, but the practice implication is investigational. Entacapone was nonefficacious as a symptomatic adjunct to levodopa in nonfluctuating patients and nonefficacious in the prevention/delay of motor complications. Rasagiline conclusions were revised to efficacious as a symptomatic adjunct, and as treatment for motor fluctuations. Clozapine was efficacious in dyskinesia, but because of safety issues, the practice implication is possibly useful. Bilateral subthalamic nucleus deep brain stimulation, bilateral globus pallidus stimulation, and unilateral pallidotomy were updated to efficacious for motor complications. Physical therapy was revised to likely efficacious as symptomatic adjunct therapy. This evidence‐based medicine review updates the field and highlights gaps for research. © 2011 Movement Disorder Society
- Parkinson's disease
- evidence‐based medicine
- levodopa
- dopamine agonists
- monoamine oxidase inhibitors
- catechol‐O‐methyl transferase inhibitors
- amantadine
- anticholinergics
- clozapine
- neurosurgery
- deep brain stimulation
- exercise
- physical therapy
- speech therapy
- occupational therapy
- acupuncture
- 1 - Health Sciences ; 2 - Medicine ; 3 - Clinical Neurology
- 1 - Life Sciences ; 2 - Neuroscience ; 3 - Neurology
- 1 - sciences appliquees, technologies et medecines ; 2 - sciences biologiques et medicales ; 3 - sciences medicales