Current Status of Symptomatic Medical Therapy in Parkinson’s Disease

Abstract

Summary: Symptomatic medical therapies for Parkinson's disease (PD) have been disease modifying and have led to improvement in daily function, quality of life, and survival. For 40 years, these therapies have been primarily dopaminergic, and currently include the dopamine (DA) precursor levodopa (LD), DA agonists, catechol-O-methyltransferase (COMT) inhibitors, and monoamine oxidase (MAO) inhibitors. The roles of all these classes of agents have evolved, with significant changes occurring since the early 2000s. This article reviews the current literature for each of these classes of drugs, with a focus on efficacy and place in the therapeutic scheme. Levodopa is no longer considered to be toxic and, thus, its early use is not only appropriate but recommended.Ergot agonists are no longer in use, and new agents administered in patch form or subcutaneous injections have been approved. The COMT inhibitor tolcapone, with its significant efficacy, has been reintroduced, and two new MAO inhibitors have been approved. Selected safety issues are discussed, including the incidence of melanoma in relation to LD; pathological gambling and DA agonists; hepatic toxicity of tolcapone; and the tyramine or so-called cheese reaction with MAO B inhibitors. The article closes with a discussion of future directions and new drugs under development.

Neuromechanical Principles Underlying Movement Modularity and Their Implications for Rehabilitation

“…Recent work has also revealed deficits in other brain regions necessary for locomotor control (Mena-Segovia et al, 2004) (Bloem et al, 2001; Bohnen and Albin, 2011; Factor, 2008; Grabli et al, 2012; Melton et al, 2006). In particular, recent attention has focused on the neuroanatomy of brainstem areas including the pedunculopontine nucleus (PPN), which degenerates in PD as well as in related disorders such as progressive supranuclear palsy (Lee et al, 2000).…”

Parkinson's Disease Therapeutics: New Developments and Challenges Since the Introduction of Levodopa

“…Currently, LD, oral dopamine receptor agonists, and MAO B inhibitors are approved by the Federal Drug Administration (FDA) for use in early and advanced PD, while COMT inhibitors and the broad-spectrum injectable dopamine agonist, apomorphine, are approved only for fluctuating PD symptoms. Clinical trials have demonstrated the usefulness of these drugs under their approved conditions (Factor, 2008).…”

Maltodextrin: A Novel Excipient Used in Sugar-Based Orally Disintegrating Tablets and Phase Transition Process

“…This dosage form is designed to disintegrate or dissolve rapidly on contact with saliva, thus eliminating the need for chewing the tablet, swallowing an intact tablet, or taking the tablet with water. This mode of administration would be beneficial to solve the problem of swallowing difficulty encountered by pediatric and geriatric patients, nauseated, psychiatric, bedridden patients, and those with parkinsonism (8)(9)(10). The main obstacles, however, encountered during ODT manufacturing include the high fragility of tablets necessitating the use of special packages and the employment of expensive equipment in the manufacturing process (10).…”