What is the best initial treatment of Parkinson's disease?

Abstract

No studies clearly demonstrate the best initial treatment for Parkinson's disease. Levodopa improves motor function in Parkinson's disease; however, long-term use is associated with irreversible dyskinesias and motor fluctuations. Compared with placebo, selegiline improves the motor symptoms of Parkinson's disease and allows a physician to delay the introduction of levodopa by 9 to 12 months (strength of recommendation [SOR]: A, based on randomized controlled trials). Dopamine agonists—alone or combined with levodopa—have fewer associated dyskinesias and other motor complications but produce lower scores on activities of daily living and Unified Parkinson's Disease Rating Scale (UPDRS) when compared with levodopa alone (SOR: A, based on systematic reviews of randomized controlled trials). Drug choices should be based on each patient's individual symptoms and response to medication.