How should you treat Parkinson Disease?

Unfortunately, research has not shown many oral therapies for idiopathic Parkinson Disease (PD) to be “disease-modifying“. Meaning treatment does not improve the long-term outcome or otherwise delay disease progression. The only exceptions to this rule in PD would be exercise and possibly rasagiline. So we have a pharmacopeia of oral, intramuscular and patch formulations of various agents that can be helpful in relieving symptoms. We go through these in detail, and briefly touch upon deep brain stimulation in our episode this week, starring Dr. David Coughlin, so check it out here:

For those of you looking for a visual aid, here is a fancy table to get you through your day:


There’s really not much else to say here. But stay tuned, in a few weeks we will be discussing the history of levodopa therapy and the drugs that preceded it in the management of PD.


[Jim Siegler]

The content in this episode was vetted and approved by Dr. Andres Deik.


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Elias, W. Jeffrey, et al. “A randomized trial of focused ultrasound thalamotomy for essential tremor.” New England Journal of Medicine 375.8 (2016): 730-739.

Hoehn, Margaret M., and Melvin D. Yahr. “Parkinsonism: onset, progression, and mortality.” Neurology 50.2 (1998): 318-318.

Hely, Mariese A., et al. “The Sydney multicenter study of Parkinson’s disease: the inevitability of dementia at 20 years.” Movement Disorders 23.6 (2008): 837-844.

McIntyre, Cameron C., et al. “Uncovering the mechanism (s) of action of deep brain stimulation: activation, inhibition, or both.” Clinical neurophysiology 115.6 (2004): 1239-1248.

Olanow, C. Warren. “Levodopa: effect on cell death and the natural history of Parkinson’s disease.” Movement Disorders 30.1 (2015): 37-44.

Parkinson Study Group. “Levodopa and the progression of Parkinson’s disease.” N Engl J Med 2004.351 (2004): 2498-2508.

Parkinson Study Group. “A randomized controlled trial comparing pramipexole with levodopa in early Parkinson’s disease: design and methods of the CALM-PD Study.” Clinical neuropharmacology 23.1 (2000): 34-44.

PD Med Collaborative Group. “Long-term effectiveness of dopamine agonists and monoamine oxidase B inhibitors compared with levodopa as initial treatment for Parkinson’s disease (PD MED): a large, open-label, pragmatic randomised trial.” The Lancet 384.9949 (2014): 1196-1205.

Weaver, Frances M., et al. “Bilateral deep brain stimulation vs best medical therapy for patients with advanced Parkinson disease: a randomized controlled trial.” Jama 301.1 (2009): 63-73.

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