Disease modification in Parkinson’s disease: are we there yet with currently available therapies?

Abstract

SUMMARY Management of Parkinson’s disease (PD) is currently based primarily on dopamine-replacement therapy for the alleviation of motor symptoms. Current medical and surgical therapies can provide long-lasting symptomatic benefit, but they do not modify progression of the disease. Research is ongoing to find a therapy that can provide neuroprotection, defined herein as preventing vulnerable neurons from dying. Studies of neuroprotection are limited by a lack of adequate biomarkers of PD progression and by the confounding symptomatic effects of many putative neuroprotective therapies. Studies have shown that levodopa prolongs life, but they have not clearly shown that it modifies disease progression. Trials of dopamine agonists have demonstrated symptomatic effect but no unequivocal neuroprotective benefits. While some studies of monamine oxidase B inhibitors have been promising, they have not conclusively proven disease modification. Exercise provides many benefits to patients with PD, may modify the progression of the disease and should be part of each patient’s treatment plan.