Goetz, C. G., Poewe W., Rascol, O. & Sampaio C. Evidence-based medical review update: pharmacological and surgical treatments of Parkinson's disease: 2001 to 2004. Mov. Disord. 20, 523-539

Department of Neurological Sciences, Department of Pharmacology, Rush University Medical Center, Chicago, Illinois 60612, USA.
Movement Disorders (Impact Factor: 5.68). 05/2005; 20(5):523-39. DOI: 10.1002/mds.20464
Source: PubMed


The objective of this study is to update a previous evidence-based medicine (EBM) review on Parkinson's disease (PD) treatments, adding January 2001 to January 2004 information. The Movement Disorder Society (MDS) Task Force prepared an EBM review of PD treatments covering data up to January 2001. The authors reviewed Level I (randomized clinical trials) reports of pharmacological and surgical interventions for PD, published as full articles in English (January 2001-January 2004). Inclusion criteria and ranking followed the original program and adhered to EBM methodology. For Efficacy Conclusions, treatments were designated Efficacious, Likely Efficacious, Non-Efficacious, or Insufficient Data. Four clinical indications were considered for each intervention: prevention of disease progression; treatment of Parkinsonism, as monotherapy and as adjuncts to levodopa where indicated; prevention of motor complications; treatment of motor complications. Twenty-seven new studies qualified for efficacy review, and others covered new safety issues. Apomorphine, piribedil, unilateral pallidotomy, and subthalamic nucleus stimulation moved upward in efficacy ratings. Rasagiline, was newly rated as Efficacious monotherapy for control of Parkinsonism. New Level I data moved human fetal nigral transplants, as performed to date, from Insufficient Data to Non- efficacious for the treatment of Parkinsonism, motor fluctuations, and dyskinesias. Selegiline was reassigned as Non-efficacious for the prevention of dyskinesias. Other designations did not change. In a field as active in clinical trials as PD, frequent updating of therapy-based reviews is essential. We consider a 3-year period a reasonable time frame for published updates and are working to establish a Web-based mechanism to update the report in an ongoing manner.

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    • "I hypothesize that these DA-depleted brain structures may be in idling states with hyper DA sensitivity and disrupted learning mechanisms (Gerfen, 2003; Hong and Hikosaka, 2011a). Consistent with this hypothesis, L-DOPA, which is known to increase the level of DA in the brain, ameliorates a host of functions in PD patients (Goetz et al., 2005; Pedrosa and Timmermann, 2013). It was reported that there was a virtually complete loss of dopaminergic markers in the postcommissural dorsal putamen in all of their samples about 4 years after the onset of the PD (Kordower et al., 2013). "
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    • "Levodopa in combination with a peripheral decarboxylase inhibitor is still the most effective medication available.18,21 Oral application of levodopa is available in different galenic formulations. "
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    • "Initial monotherapy with pramipexole is among the first-line treatment approaches to early Parkinson’s disease recommended in major international guidelines as a means to delay the occurrence of motor complications induced by levodopa.25,39 Pramipexole is also efficacious and safe as adjunctive therapy to reduce motor response oscillations in levodopa-treated patients with Parkinson’s disease.39–42 However, recent studies have clearly established that once-daily drugs are associated with the highest value for total or daily drug adherence and, in particular, timing adherence.36 "
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