The overview of the therapeutic strategy for motor complications of Parkinson's disease

Abstract

Currently, levodopa remains to be the most effective agent to improve motor symptoms in Parkinson's disease (PD). However, the chronic use is associated with the emergence of motor fluctuations, which has been one of the most troublesome dilemmas in PD's treatment. A plenty of clinical studies evidenced some risk factors would contribute to the emergence of the motor complications. Therefore, a better understanding of these risk factors may help to draw up the preventive strategies to target "at risk" populations before the onset of motor complications. Therapeutic strategies using different types and timing of dopaminergic therapy may influence the emergence of motor complications. Unfortunately, the traditional oral treatments for motor complications are only partially effective, rarely abolishing motor complications. The clinical improvement might be achieved with invasive strategies via subcutaneous or intraduodenal delivery of apomorphine or levodopa, or deep brain stimulation (DBS) of the subthalamic nucleus, especially
at late stage of PD. Besides, targeting transmitter systems beyond the dopamine system is another interesting approach for the motor complications of PD. However, clinical trail evidence regarding the medicine has been inconsistent. The treatment of motor complications is a long-term project, and the strategies should be modified to solve the demands at different stages.