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Pharmacological treatment of Parkinson's disease
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  1. A Münchau,
  2. K P Bhatia
  1. National Hospital for Neurology and Neurosurgery, London WC1N 3BG, UK
  1. Dr Kailash P Bhatia, University Department of Clinical Neurology, Institute of Neurology, Queen Square, London WC1N 3BG, UK (email: K.Bhatia{at}ion.ucl.ac.uk)

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Parkinson's disease is a neurodegenerative disorder of unknown cause. Age is the most consistent risk factor and incidence in the general population over 75 years of age is 254:100 000.1With an aging population the management of Parkinson's disease is likely to prove an increasingly important and challenging aspect of medical practice. Classically Parkinson's disease presents with resting tremor, rigidity, and akinesia often in an asymmetric fashion, but later usually bilateral. However, initial symptoms may be subtle and vague, for example discomfort or mild stiffness in the limbs, and may be misinterpreted. Moreover clinical features are variable with some patients presenting with akinesia and rigidity only and others with a tremor dominant type. About 10%–20% of autopsy cases with a diagnosis of Parkinson's disease were not considered to suffer from it in life.2 On the other hand, approximately 25% of patients with a diagnosis of Parkinson's disease in life are shown to have a different diagnosis when postmortem examination is carried out.3 4 Diagnosis may thus be difficult particularly as there are no biological markers that unequivocally confirm the diagnosis of Parkinson's disease. The most common differential diagnoses are essential tremor, arteriosclerotic pseudoparkinsonism, drug induced parkinsonism,5 and the so-called Parkinson plus syndromes namely multiple system atrophy,6 7progressive supranuclear palsy,8 9 and corticobasal degeneration.10

Drugs used in Parkinson's disease

In the following sections a summary of drugs currently in use in the UK will be provided. The optimum use of antiparkinsonian drugs and the timing of treatment are matters of debate. This will be discussed later. Also, dose recommendations will be given later.

L-DOPA

Degeneration in the basal ganglia in the brains of Parkinson's disease patients primarily affects dopaminergic neurons in the substantia nigra which results in dopamine deficiency. Exogenous L-dopa replaces endogenous deficient neurotransmitter. L-dopa is taken up by …

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