The management of motor dysfunction in PD

Abstract

Parkinson disease (PD) is a slowly progressing neurodegenerative disease with typical features such as bradykinesia, resting tremor, and cogwheel rigidity. The pathological hallmarks of PD are marked loss of dopaminergic neurons in the substantia nigra pars compacta (SNc) ; therefore, dopamine replacement therapy improves the motor dysfunction of PD. Although L–dopa is the most effective drug for PD, long term L–dopa treatment is usually associated with motor complications, such as L–dopa–induced dyskinesia and wearing off.

On the other hand, dopamine agonists and MAO–B inhibitors, which are second line drugs for PD, might be associated with little motor fluctuations. However, they have a lesser anti–parkinsonian effect than L–dopa and have many adverse effects, such as sleep disturbance, impulse control disorder, orthostatic hypotension, psychosis, and so on.

In patients with advanced PD, L–dopa–induced motor complications, including dyskinesia and wearing off, are usually associated with impairment of quality of life and activity of daily living. In this article, we reviewed the management of motor dysfunction in PD.