American Academy of Neurology Publishes New Parkinson Disease Guideline 

The American Academy of Neurology (AAN) has issued an updated guideline that provides recommendations for treating motor symptoms in people with early Parkinson disease (PD). This guideline updates recommendations on dopaminergic medications published in the 2002 AAN guideline on initiating treatment for PD. 

“We carefully reviewed the available research on the effectiveness and possible risks of medications to treat motor symptoms in people with early PD and found that levodopa is usually the best first treatment for these symptoms,” said guideline lead author Tamara Pringsheim, MD, MSc, University of Calgary. “Still, there are side effects with levodopa as well as other drugs, so it is important that a person newly diagnosed with PD discusses all options with their neurologist before deciding on the best treatment plan for them.” 

The guideline recommends that neurologists counsel people with early PD on the benefits and risks of initial therapy with levodopa, dopamine agonists, and monoamine oxidase B (MAO-B) inhibitors.  Although all 3 medications may help alleviate motor symptoms, levodopa provides superior benefit for motor symptoms compared with treatment with either dopamine agonists or MAO-B inhibitors. 

Additionally, people with PD are more likely to adhere to treatment with levodopa and more likely to stop treatment because of side effects with dopamine agonists and MAO-B inhibitors. Side effects of dopamine agonists include impulse-control disorders, excessive daytime sleepiness, and hallucinations. People taking MAO-B inhibitors are more likely to require additional therapies within 2 to 3 years.  

Although initial treatment with levodopa vs dopamine agonists is more likely to cause dyskinesia during the first 5 years of treatment, the prevalence of severe or disabling dyskinesia is low during this time frame. The lowest effective dose of levodopa is recommended to optimize benefit and minimize the risk of dyskinesia. 

The guideline is published in the November 15, 2021, online issue of Neurology and is endorsed by the Parkinson’s Foundation.