AAN issues new guideline for treatment of early PD
The American Academy of Neurology has issued a guideline providing recommendations for treating motor symptoms in people with early Parkinson’s disease.
The guideline, published in Neurology, was endorsed by the Parkinson’s Foundation. It updates recommendations on dopaminergic medications that were first published in a 2002 AAN guideline on the initiation of treatment for PD.
Dopamine-releasing medications have been used to relieve initial PD symptoms, such as motor symptoms including tremor, rigidity and bradykinesia.
“We carefully reviewed the available research on the effectiveness and possible risks of medications to treat motor symptoms in people with early [PD] and found that levodopa is usually the best first treatment for these symptoms,” guideline lead author Tamara Pringsheim, MD, MSc, of the University of Calgary and a fellow of AAN, said in a press release. “Still, there are side effects with levodopa as well as other drugs, so it is important that a person newly diagnosed with [PD] discusses all options with their neurologist before deciding on the best treatment plan for them.”
The guideline recommends that neurologists should counsel patients who exhibit signs of early PD on the benefits and risks of initial therapy with three treatment options: levodopa, dopamine agonists and monoamine oxidase B (MAO-B) inhibitors. It also states that medications may help alleviate motor symptoms.
According to the new recommendations, treatment with levodopa was found to provide superior benefits in reducing motor symptoms when compared with treatment with either dopamine agonists or MAO-B inhibitors.
The guideline also noted that initial treatment with levodopa was more likely than initial treatment with dopamine agonists to cause dyskinesia during the first 5 years of treatment. Therefore, the guideline authors recommended neurologists prescribe the lowest effective dose of levodopa to optimize benefits and minimize any risk for dyskinesia.
Although dopamine agonists were less likely to cause such involuntary movements, the authors noted that they were more likely to cause impulse-control disorders, such as compulsive gambling, eating, shopping or sexual activity, as well as hallucinations. Dopamine agonists are also associated with a greater risk for drowsiness in the daytime, so people with jobs that require driving or operating heavy machinery may face a greater risk for impairment from side effects of the drug.
The authors also highlighted that patients were more likely to halt treatment due to side effects when taking dopamine agonists and MAO-B inhibitors than when taking levodopa. Further, people taking MAO-B inhibitors were more likely to require additional therapy within 2 to 3 years.
“Choosing to start a medication is a collaborative decision between a person with [PD], their neurologist and their caregiver,” Pringsheim said in the release. “The right medication will depend on a person’s symptoms, age and life circumstances. They are encouraged to discuss the potential benefits and adverse effects of medication options with their neurologist and care team.”