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MEDICAL MANAGEMENT OF PARKINSON'S DISEASE
  1. C E Clarke
  1. Correspondence to:
 Dr C E Clarke, Department of Neurology, City Hospital NHS Trust, Dudley Road, Birmingham B18 7QH, UK;
 c.e.clarke{at}bham.ac.uk

https://doi.org/10.1136/jnnp.72.suppl_1.i22

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    The management of Parkinson's disease has evolved rapidly over the last 10 years with the advent of new drugs, new classes of drug, and the resurgence of interest in surgery. Although there has been a move toward patients being cared for by neurologists or geriatricians with a special interest in the condition, along with a Parkinson's disease nurse specialist, for the foreseeable future most general neurologists will continue to treat patients with the condition.

    The present review uses an evidence based approach to provide an update on the current place of medical treatment for Parkinson's disease. Unfortunately, in light of the lack of evidence in many areas, it is not always possible to be prescriptive and many treatment decisions must be left to the judgement of the individual clinician and the desires of patients.

    EARLY PARKINSON'S DISEASE

    The major issues regarding the difficulty in the clinical diagnosis of Parkinson's disease have been outlined already in this supplement (see p i10). It will be assumed in this review that the patient has idiopathic Parkinson's disease with significant functional disability that requires treatment.

    Neuroprotection

    The definitions of terms in relation to neuroprotection are outlined in table 1 and fig 1.1 The effects of this approach to treatment in Parkinson's disease can be measured in three ways:

    • Comparison of the mortality rate on the putative neuroprotective agent with that in a control population within the setting of a randomised controlled trial (RCT)

    • Measuring the decline in 18F-fluorodopa uptake by dopaminergic neurones in the striatum using positron emission tomography (PET) to demonstrate reduced decline in the group treated with the neuroprotective agent

    • During a total drug “wash out” period at the end of an RCT, rating scales (for example, unified Parkinson's disease rating scale (UPDRS), total or motor score) decline less in those treated with the …

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