ABSTRACT
The treatment of Parkinson’s disease (PD) is continuously evolving. The last three decades have witnessed an explosion of new drugs with different mechanisms of action for improving not only the motor symptoms of PD but also the autonomic, psychiatric, and cognitive symptoms that negatively affect daily living. Treatment trends have shifted from surgery (before the revolutionary discovery of levodopa) to medical treatment and back to surgery (with the advances in stereotactic procedures and transplantation and disappointment with the poorly manageable side effects of levodopa). The current medical therapy for the motor symptoms of the disease includes levodopa preparations, dopamine agonists, dopamine extenders such as monoamine oxidase B (MAO-B) inhibitors, and catechol-O-methyl transferase (COMT) inhibitors. Anticholinergic, serotoninergic, noradrenergic, and gabaergic medications are used to treat the secondary long-term dopaminergic symptoms and the nonmotor symptoms (Table 68.1). The future holds much promise for PD patients. This chapter envisions what the next decades may look like in terms of the symptomatic medical treatment of PD.
