Opinion|Videos|April 23, 2025
Adjusting and Changing Treatment Regimens in Parkinson Disease
Panelists discuss how treatment changes in Parkinson disease are necessitated by disease progression, diminishing medication effectiveness, and emerging motor complications, examining a physician’s systematic approach to treatment adjustments and the range of available options for managing off fluctuations.
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Treatment Changes and Options for Off Fluctuations
Primary Reasons for Treatment Changes:
- Diminishing efficacy of current regimen
- Emergence/worsening of motor fluctuations and dyskinesias
- Development of adverse effects
- Disease progression affecting nonmotor symptoms
- Cognitive decline affecting medication adherence
Process for Treatment Adjustment:
- Assess pattern and timing of symptoms (symptom diaries)
- Optimize oral levodopa dosing (dose/frequency adjustments)
- Add adjunctive medications strategically
- Consider advanced therapies when oral medications are inadequate
- Regular follow-up to monitor response and adjust as needed
Current Options for Off Fluctuations:
- Levodopa optimization: dose adjustments, controlled-release formulations
- Adjunctive therapies: COMT inhibitors, MAO-B inhibitors, dopamine agonists
- Rescue therapies: apomorphine injection, levodopa inhalation powder, sublingual apomorphine
- Advanced therapies: deep brain stimulation, continuous infusion therapies (levodopa intestinal gel, subcutaneous apomorphine)
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