Current Treatment

While non-dopaminergic agents used for adjunct PD treatment include the weak NMDA antagonist amantadine 55 and the anti-cholinergics, trihexyphenidyl 56 and benztropine 57, the most effective drugs used to treat PD all modulate the dopaminergic system, either via regulation of DA synthesis, blockade of synaptic reuptake or via direct activation of DA receptors. Drugs used for PD treatment provide symptomatic improvement, either as primary treatment or adjunct therapy. The gold standard is L-dopa 51 introduced in the mid-1970s. Direct DA receptor agonists, e.g., apomorphine 58, bromocriptine 59, pramipexole 60, ropinirole 61, and pergolide 62, have been increasingly used as firstline therapy to delay onset of motor fluctuations and dyskinesias that typically occur with long-term L-dopa use.70 In patients with advanced PD, DA receptor agonists are used in combination with L-dopa to 'spare' L-dopa therapy. There is currently no approved treatment for slowing PD progression.

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