Pharmacotherapy of motor symptoms in early and mid-stage Parkinson’s disease

Höllerhage, Matthias ; Becktepe, Jos; Classen, Joseph; Deuschl, Günther; Ebersbach, Georg; Hopfner, Franziska ; Lingor, Paul; Löhle, Matthias; Maaß, Sylvia; Pötter-Nerger, Monika; Odin, Per; Woitalla, Dirk; Bähr, Mathias; Berg, Daniela; Brockmann, Kathrin ; Buhmann, Carsten ; Ceballos-Baumann, Andrés O.; Claßen, Joseph; Deuschl, Cornelius; Dodel, Richard; Eggers, Carsten; Eimeren, Thilo van; Fanciulli, Alessandra; Fimm, Bruno; Folkerts, Ann-Kristin; Gausepohl, Madeleine; Hasan, Alkomiet; Hermann, Wiebke; Hilker-Roggendorf, Rüdiger; Höglinger, Günter ; Jost, Wolfgang H. ; Kalbe, Elke; Kassubek, Jan ; Klebe, Stephan; Klein, Christine; Klietz, Martin ; Köglsperger, Thomas; Kühn, Andrea ; Krack, Paul; Krismer, Florian; Kuhlenbäumer, Gregor ; Levin, Johannes ; Liepelt-Scarfone, Inga; Loewenbrück, Kai; Lorenzl, Stefan; Maetzler, Walter; Menzel, Regina; Meyer, Philipp T.; Mollenhauer, Brit ; Neumann, Manuela; Outeiro, Tiago F. ; Reese, René; Reetz, Kathrin; Rieß, Olaf; Ruf, Viktoria; Schneider, Anja ; Schrader, Christoph; Schnitzler, Alfons; Seppi, Klaus; Sixel-Döring, Friederike; Storch, Alexander; Tönges, Lars ; Eimeren, Thilo van; Walter, Uwe ; Wächter, Tobias; Warnecke, Tobias; Wegner, Florian ; Winkler, Christiane; Witt, Karsten ; Zeuner, Kirsten; Trenkwalder, Claudia und Höglinger, Günter U. (2024): Pharmacotherapy of motor symptoms in early and mid-stage Parkinson’s disease. Guideline “Parkinson’s disease” of the German Society of Neurology. In: Journal of Neurology, Vol. 271, No. 11: pp. 7071-7101

Abstract

Background and objective : There are multiple pharmacological treatment options for motor symptoms of Parkinson’s disease (PD). These comprise multiple drug classes which are approved for the condition, including levodopa, dopamine agonists, COMT inhibitors, MAO-B inhibitors, NMDA-receptor antagonists, anticholinergics, and others. Some of the drugs are approved for monotherapy and combination therapy while others are only approved as adjunctive therapy to levodopa. Furthermore, treatment for special treatment situations, e.g., rescue medication for off-phases, for tremor, treatment during pregnancy and breast feeding is discussed and recommendations are given with further details. Methods : The recommendations were based on systematic literature reviews, drafted by expert teams, consented in online polls followed by online consensus meetings of the whole German Parkinson’s Guideline Group, and publicly released in November 2023. Results : In the new S2k (i.e., consensus-based) guidelines, the pharmacotherapy of the motor symptoms of PD is discussed in five chapters. These comprise “Parkinson medication”, “Initial monotherapy”, “Early combination therapy”, “Fluctuations and dyskinesia”, and “Parkinsonian tremor”. Furthermore, there is a chapter for special treatment situations, including perioperative management, freezing of gait, and pregnancy and breastfeeding. Conclusion : The recommendations for the pharmacotherapy of motor symptoms of PD have been updated. Newly available drugs have been added, while other drugs (e.g., ergoline dopamine agonists, anticholinergics, budipine) have been removed from the recommendations.

• Item Type: Journal article
• Faculties: Medicine > Munich Cluster for Systems Neurology (SyNergy); Medicine > Institute for Stroke and Dementia Research (ISD); Medicine > Medical Center of the University of Munich > Neurological Clinic and Polyclinic with Friedrich Baur Institute
• Subjects: 600 Technology > 610 Medicine and health
• ISSN: 0340-5354
• Language: English
• DFG: Gefördert durch die Deutsche Forschungsgemeinschaft (DFG) - 390857198