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Article

Managing the patient with newly diagnosed Parkinson disease

Hubert H. Fernandez, MD, Nestor Galvez-Jimenez, MD and Carlos Singer, MD
Cleveland Clinic Journal of Medicine July 2012, 79 (7 suppl 2) S3-S7; DOI: https://doi.org/10.3949/ccjm.79.s2a.01
Hubert H. Fernandez
Cleveland Clinic
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Nestor Galvez-Jimenez
Cleveland Clinic Florida
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Carlos Singer
Professor of Neurology, Chief, Center for Parkinson’s Disease and Movement Disorders, Leonard M. Miller School of Medicine, University of Miami, Miami, FL
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ABSTRACT

The treatment of early Parkinson disease (PD) is generally symptomatic, although therapy that also offers neuroprotection in early-stage PD would be welcomed. Levodopa remains the most effective agent for relief of PD symptoms, but chronic levodopa therapy is associated with motor fluctuations and dyskinesias, and clinicians may therefore opt to postpone its use. Alternatives to levodopa in early PD include monoamine oxidase (MAO)-B inhibitors, amantadine, and dopamine agonists. MAO-B inhibitors have only mild symptomatic effects. Amantadine is associated with improvement in functional disability and, in a subset of PD patients, a robust symptomatic improvement. Dopamine agonists improve symptoms and may have a neuroprotective effect. Partial dopamine agonists, adenosine A2A-receptor antagonists, and safinamide are symptomatic therapies that are under investigation. Neuro protective strategies under study include enhancement of mitochondrial function, antiinflammatory mechanisms, calcium channel blockade, and uric acid elevation. Deep brain stimulation may slow cognitive and motor decline when used in early PD. Stem cell therapy and gene therapy are still under investigation.

  • Copyright © 2012 The Cleveland Clinic Foundation. All Rights Reserved.
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Cleveland Clinic Journal of Medicine: 79 (7 suppl 2)
Cleveland Clinic Journal of Medicine
Vol. 79, Issue 7 suppl 2
1 Jul 2012
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Managing the patient with newly diagnosed Parkinson disease
Hubert H. Fernandez, Nestor Galvez-Jimenez, Carlos Singer
Cleveland Clinic Journal of Medicine Jul 2012, 79 (7 suppl 2) S3-S7; DOI: 10.3949/ccjm.79.s2a.01

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Managing the patient with newly diagnosed Parkinson disease
Hubert H. Fernandez, Nestor Galvez-Jimenez, Carlos Singer
Cleveland Clinic Journal of Medicine Jul 2012, 79 (7 suppl 2) S3-S7; DOI: 10.3949/ccjm.79.s2a.01
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