Dopaminergic Therapy for Motor Symptoms in Early Parkinson Disease Practice Guideline Summary: A Report of the AAN Guideline Subcommittee
Document Type
Article
Publication Date
11-15-2021
Publication Title
Neurology
DOI
10.1212/WNL.0000000000012868
Abstract
Background and Objectives
To review the current evidence on the options available for initiating dopaminergic treatment of motor symptoms in early-stage Parkinson disease and provide recommendations to clinicians.
Methods
A multidisciplinary panel developed practice recommendations, integrating findings from a systematic review and following an Institute of Medicine–compliant process to ensure transparency and patient engagement. Recommendations were supported by structured rationales, integrating evidence from the systematic review, related evidence, principles of care, and inferences from evidence.
Results
Initial treatment with levodopa provides superior motor benefit compared to treatment with dopamine agonists, whereas levodopa is more likely than dopamine agonists to cause dyskinesia. The comparison of different formulations of dopamine agonists yielded little evidence that any one formulation or method of administration is superior. Long-acting forms of levodopa and levodopa with entacapone do not appear to differ in efficacy from immediate release levodopa for motor symptoms in early disease. There is a higher risk of impulse control disorders associated with the use of dopamine agonists than levodopa. Recommendations on initial therapy for motor symptoms are provided to assist the clinician and patient in choosing between treatment options and to guide counseling, prescribing, and monitoring of efficacy and safety.
Recommended Citation
Pringsheim, Tamara, Gregory S. Day, Don B. Smith, Alex Rae- Grant, Nicole Licking, Melissa J. Armstrong, Rob M. A. de Bie, Emmanuel Roze, Janis M. Miyasaki, Robert A. Hauser, Alberto J. Espay, Justin P. Martello, Julie Gurwell, Lori Billinghurst, Kelly L. Sullivan, Michael Fitts, Nicholas Cothros, Deborah A. Hall, Miriam Rafferty, Lynn Hagerbrant, Tara Hastings, Mary Dolan O’Brien, Heather Silsbee, Gary Gronseth, Anthony E. Lang.
2021.
"Dopaminergic Therapy for Motor Symptoms in Early Parkinson Disease Practice Guideline Summary: A Report of the AAN Guideline Subcommittee."
Neurology, 97 (20): 942-957: American Academy of Neurology.
doi: 10.1212/WNL.0000000000012868
https://digitalcommons.georgiasouthern.edu/bee-facpubs/355
Copyright
Copyright © 2021 American Academy of Neurology.
Comments
Georgia Southern University faculty member, Kelly Sullivan co-authored Dopaminergic Therapy for Motor Symptoms in Early Parkinson Disease Practice Guideline Summary: A Report of the AAN Guideline Subcommittee.