Where do we stand in the treatment of Parkinson's disease?

This article reviews the current situation regarding the treatment of Parkinson's disease (PD). How to apply the various therapeutic options to treat PD appears to be internationally agreed, but the currently available treatment methods are said to be all symptomatic ones. However, some of these may have marginal disease modifying effects. In addition, there are many investigational interventions aiming at modification of the disease processes; some of these interesting strategies are reviewed here. Regarding the currently available drugs, dopamine agonists may delay the loss of dopamine transporters in the striatum and even L-dopa may have some neuroprotective effects. Monoamine oxidase B inhibitors and coenzyme Q(10) may also be disease modifying. Recently, a more systemic approach to finding disease modifying drugs has been initiated in the United States which has revealed that creatine and minocycline might have a small disease modifying effect. Although the disease modifying effect of each drug is small, eventually it may be possible to find more potent drugs for PD using this approach. Another important issue is to exchange specialists' "knowhow" on the management of various problems arising from long-term L-dopa treatment such as disabling dyskinesia. Although it has not been proven by controlled clinical trials, giving small amounts of liquid L-dopa in frequent doses may be helpful in reducing the severity of dyskinesia and wearing off phenomenon.