St. Paul, Minn. – A re-examination of the practice guidelines for the treatment of Parkinson''s disease suggest that, despite the introduction of new drug therapies since 1993, when the AAN last released the guidelines, treatment strategies remain unchanged. The guideline is published in the January 8 issue of Neurology. The last set of guidelines released by the American Academy of Neurology concluded that levodopa was the most effective in treating the motor symptoms of the disorder.
Neurologists with expertise in Parkinson''s disease were selected by the AAN Quality Standards Subcommittee to review the literature and make recommendations. The Quality Standards Subcommittee is charged with developing practice guidelines for neurologists for diagnostic procedures, treatment modalities, and clinical disorders.
The neurologists reviewed hundreds of pieces of Parkinson''s treatment literature published between 1966 and 2001.
According to Janis M. Miyasaki, MD, a neurologist at Toronto Western Hospital in Toronto, Ontario, Canada, the Academy sought to examine whether the new compounds were more effective in treating de novo PD patients, or those in the early stages of the disease. There are currently three options in practice, depending on the patient. Each carries concern about side-effects and physicians determine treatment on a case-by-case basis.
The committee studied selegiline and its neuroprotection capabilities; whether there was a benefit of sustained-release levedopa over immediate-release levodopa; and what is the best dopamine replacement therapy in de novo Parkinson''s.
The guidelines offer that:
* While providing superior motor benefit, levodopa remains associated with a higher risk of dyskinesia. (Dyskinesia, or abnormal movement, is the most common side effect of Parkinson''s drug therapy.)
* There was no evidence that initiating treatment with sustained release levodopa was an advantage over immediate release levodopa.
* There was insufficient evidence to recommend the use of selegiline for neuroprotection against Parkinson''s.
Stanley Fahn, MD, president of the AAN and a Parkinson''s researcher at the Neurological Institute in New York, said "the published guidelines offer a succinct review of the pertinent clinical trials literature on Parkinson''''''''s disease. These studies show that while dopamine agonists are less likely than levodopa to induce dyskinesias and motor fluctuations, levodopa is was found to be more powerful in reducing the symptoms of parkinsonism. The clinician and patient need to use their judgment on the optimal treatment in any given patient."
The American Academy of Neurology, an association of more than 19,000 neurologists and neuroscience professionals, is dedicated to improving patient care through education and research. A neurologist is a doctor with specialized training in diagnosing, treating and managing disorders of the brain and nervous system such as stroke, Alzheimer's disease, epilepsy, Parkinson's disease, autism and multiple sclerosis.
For more information about the American Academy of Neurology, visit www.aan.com.
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Editor's Notes: The guideline is available at http://www.aan.com/professionals/practice/guideline/index.cfm.