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Initial Treatment of Parkinson’s Disease: An Update

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Opinion statement

This is an update to an article published in this journal in 2006, which covered the initial treatment of Parkinson’s disease (PD). In this update, we review new research into symptomatic treatments, potential disease modifying (“neuroprotective”) agents, and evidence-based reviews of current treatment. We discuss the usage of the MAO-B inhibitors, including the controversy surrounding the possible neuroprotective effects of rasagiline. Usage of extended release formulations of pramipexole and ropinirole, as well as the transdermal dopamine agonist rotigotine, are reviewed. Side effects of the dopamine agonists are discussed, including the cardiac side effects of ergot-derived dopamine agonists, and the impulse control disorders associated with the dopamine agonists. The use of zonisamide as an agent for PD tremor is reviewed. We touch on the clinical research into the benefits of exercise in PD, and briefly review some of the current studies for new formulations of levodopa and other medications and treatments with novel mechanisms of action.

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Conflict of Interest

Scott Kaplan declares that he has no conflict of interest.

Daniel Tarsy has served as a consultant for Neurocrine Biosciences, Eisai, Genzyme, Best Doctors, and Advanced Medical; has provided expert testimony in a series of cases related to tardive dyskinesia; has received grant support from Phytopharm PLC, the Michael J. Fox Foundation, Allergan, Teva Pharmaceuticals, and Ipsen; has received royalties from UpToDate and Springer; has received honoraria from the Movement Disorders Society; and has received foundation support from the National Parkinson Foundation.

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Authors and Affiliations

  1. Department of Neurology, Harvard Medical School, Parkinson’s Disease and Movement Disorders Center, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA, 02215, USA

    Scott Kaplan MD & Daniel Tarsy MD

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  1. Scott Kaplan MD
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Correspondence to Daniel Tarsy MD.

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Kaplan, S., Tarsy, D. Initial Treatment of Parkinson’s Disease: An Update. Curr Treat Options Neurol 15, 377–384 (2013). https://doi.org/10.1007/s11940-013-0236-7

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