Parkinson’s disease (PD) is a chronic progressive neurodegenerative disorder characterized by striatal dopaminergic loss with no cure available at present. Traditional drug therapy has consisted of levodopa (usually in combination with carbidopa). This drug has the disadvantage of significant motor fluctuations in the long term in the form of “on-off, “delayed on” or “no on” phenomena. These can be effectively managed by adding various other agents including MAO-B inhibitors (e.g. selegiline) and COMT inhibitors (e.g. tolcapone). Dopamine agonists have also been used as initial therapy with good results. Accurate diagnosis and individualized assessment of the risks and benefits of available antiparkinsonian medications should guide initiation of treatment for patients with early PD. In advanced cases various surgical techniques can serve as helpful adjuncts for the relief of symptoms in PD. The latest modes of medical and surgical therapy for PD are reviewed.
