Effective Treatment Strategies for Motor and Nonmotor Symptoms of Parkinson Disease

Which medications can improve the motor and nonmotor symptoms of Parkinson disease? Dr Isaacson offers strategies to address multiple challenges.

Abstract

Although levodopa is an effective medication for the treatment of Parkinson disease, physicians and patients face significant management challenges related to disease progression. Patients typically develop fluctuations in motor symptoms and dyskinesias. Novel treatment options may help clinicians more effectively manage patients’ symptoms by extending the duration of response to medication, with improved tolerance. For many patients, nonmotor symptoms impact daily activities more than motor symptoms do. Many pharmacotherapeutic strategies are approved to address motor and nonmotor symptoms and fluctuations. A clear understanding of the advantages and potential adverse effects of each therapy can help clinicians individualize the choice and timing of medications to optimize patient response and hopefully improve quality of life.

From the Series: Earlier Diagnosis and Expanded Treatment Options for Patients With Parkinson Disease

To cite: Isaacson SH. Effective treatment strategies for motor and nonmotor symptoms of Parkinson disease. J Clin Psychiatry. 2020;81(1):MS18003BR2C.

To share: https://doi.org/10.4088/JCP.MS18003BR2C

© Copyright 2019 Physicians Postgraduate Press, Inc.

Target Audience

  • Neurologists

Learning Objectives

After completing this educational activity, you should be able to:

  • Provide evolving treatment for the motor symptoms of PD as the patient’s disease progresses
  • Address nonmotor symptoms of PD in the treatment plan
Activity summary
Available credit: 
  • 0.50 AMA PRA Category 1 Credit™
  • 0.50 Participation
Activity opens: 
12/12/2019
Activity expires: 
12/31/2021
Cost:
$0.00
Rating: 
0

Support Statement

Supported by educational grants from Biogen MA, Inc.; Lundbeck LLC; and Sunovion Pharmaceuticals, Inc.

Learning Objective

After completing this educational activity, you should be able to:

  • Provide evolving treatment for the motor symptoms of PD as the patient’s disease progresses
  • Address nonmotor symptoms of PD in the treatment plan

Release, Review, and Expiration Dates

This brief report activity was published in December 2019 and is eligible for AMA PRA Category 1 Credit™ through December 31, 2021. The latest review of this material was November 2019.

Statement of Need and Purpose

Because clinicians have incorrectly diagnosed patients with PD who did not have the disease and have not diagnosed those who do have PD, they need information on diagnostic criteria for PD and strategies to improve clinical observations. In addition, when motor symptoms present or worsen, treatment change is often needed. However, there are discrepancies among physicians regarding what treatment changes to make. Patients also say they have heard of advanced treatment options that their clinicians have not discussed with them. Clinicians, then, need education about recently updated guidelines for treating the motor symptoms of PD and how to adjust treatment as the disease progresses and the patient’s response to medication changes. They need to be familiar with the latest treatment advances to best manage OFF episodes and have an appreciation for emerging agents that are moving beyond dopamine and into the realm of disease modification and neuroprotection. Even when clinicians show familiarity with motor symptoms, they must also be aware of nonmotor symptoms and therapeutic strategies. To aid in recognition of nonmotor symptoms, clinicians need education about talking with patients and the use of patient questionnaires, as well as on the importance of addressing nonmotor symptoms and on options for treating these symptoms. This activity was designed to meet the needs of participants in CME activities provided by the CME Institute of Physicians Postgraduate Press, Inc., who have requested information on PD.

Disclosure of Off-Label Usage

The author has determined that, to the best of his knowledge, levodopa and apomorphine administered by a continuous pump; sublingual apomorphine; opicapone; and domperidone are not approved by the US Food and Drug Administration for the treatment of Parkinson disease.

Review Process

The faculty member(s) agreed to provide a balanced and evidence-based presentation and discussed the topic(s) and CME objective(s) during the planning sessions. The faculty’s submitted content was validated by CME Institute staff, and the activity was evaluated for accuracy, use of evidence, and fair balance by a peer reviewer who is without conflict of interest.

Acknowledgment

This brief report is derived from the teleconference series “Earlier Diagnosis and Expanded Treatment Options for Parkinson Disease,” which was held in July 2019 and supported by educational grants from Biogen MA, Inc.; Lundbeck LLC; and Sunovion Pharmaceuticals, Inc. The opinions expressed herein are those of the faculty and do not necessarily reflect the opinions of the CME provider and publisher or the commercial supporters.

Faculty Affiliation


Stuart H. Isaacson, MD
Boca Raton Regional Hospital, Florida
 

Financial Disclosure

The faculty for this CME activity and the CME Institute staff were asked to complete a statement regarding all relevant personal and financial relationships between themselves or their spouse/partner and any commercial interest. The Accreditation Council for Continuing Medical Education (ACCME) defines a commercial interest as any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients. The ACCME defines relevant financial relationships as financial relationships in any amount occurring within the past 12 months that create a conflict of interest. The CME Institute has resolved any conflicts of interest that were identified. No member of the CME Institute staff reported any relevant personal financial relationships. Faculty financial disclosure is as follows:

Dr Isaacson has received grant/research support and honoraria from and is a member of the speakers bureaus for Abbvie, Acadia, Acorda, Adamas, Addex, Allergan, Amarantus, Axovant, Benevolent, Biogen, Britannia, Cerecor, Eli Lilly, Enterin, GE Healthcare, Global Kinetics, Impax, Intec Pharma, Ipsen, Jazz, Kyowa, Lundbeck, Michael J. Fox Foundation, Neurocrine, Neuroderm, Parkinson Study Group, Pharma2B, Roche, Sanofi, Sunovion, Teva, Theravance, UCB, US World Meds, and Zambon.

Accreditation Statement

The CME Institute of Physicians Postgraduate Press, Inc., is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

 

 

Credit Designation

The CME Institute of Physicians Postgraduate Press, Inc., designates this enduring material for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Note: The American Nurses Credentialing Center (ANCC) and the American Academy of Physician Assistants (AAPA) accept certificates of participation for educational activities certified for AMA PRA Category 1 Credit™ from organizations accredited by the ACCME.

To obtain credit for this activity, study the material and complete the CME Posttest and Evaluation.

MOC Approval Statement

Through the American Board of Medical Specialties (“ABMS”) ongoing commitment to increase access to practice relevant Continuing Certification Activities through the ABMS Continuing Certification DirectoryEffective Treatment Strategies for Motor and Nonmotor Symptoms of Parkinson Disease has met the requirements as a MOC Part II CME Activity (apply toward general CME requirement) for the following ABMS Member Boards:

MOC Part II CME Activity

Psychiatry and Neurology

Available Credit

  • 0.50 AMA PRA Category 1 Credit™
  • 0.50 Participation

Price

Cost:
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