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Pharmacotherapy of motor symptoms in early and mid-stage Parkinson’s disease: guideline “Parkinson’s disease” of the German Society of Neurology

Höllerhage, M. ; Odin, P. LU orcid and Höglinger, G.U. (2024) In Journal of Neurology 271. p.7071-7101
Abstract
Background and objective: There are multiple pharmacological treatment options for motor symptoms of Parkinson’s disease (PD). These comprise multiple drug classes which are approved for the condition, including levodopa, dopamine agonists, COMT inhibitors, MAO-B inhibitors, NMDA-receptor antagonists, anticholinergics, and others. Some of the drugs are approved for monotherapy and combination therapy while others are only approved as adjunctive therapy to levodopa. Furthermore, treatment for special treatment situations, e.g., rescue medication for off-phases, for tremor, treatment during pregnancy and breast feeding is discussed and recommendations are given with further details. Methods: The recommendations were based on systematic... (More)
Background and objective: There are multiple pharmacological treatment options for motor symptoms of Parkinson’s disease (PD). These comprise multiple drug classes which are approved for the condition, including levodopa, dopamine agonists, COMT inhibitors, MAO-B inhibitors, NMDA-receptor antagonists, anticholinergics, and others. Some of the drugs are approved for monotherapy and combination therapy while others are only approved as adjunctive therapy to levodopa. Furthermore, treatment for special treatment situations, e.g., rescue medication for off-phases, for tremor, treatment during pregnancy and breast feeding is discussed and recommendations are given with further details. Methods: The recommendations were based on systematic literature reviews, drafted by expert teams, consented in online polls followed by online consensus meetings of the whole German Parkinson’s Guideline Group, and publicly released in November 2023. Results: In the new S2k (i.e., consensus-based) guidelines, the pharmacotherapy of the motor symptoms of PD is discussed in five chapters. These comprise “Parkinson medication”, “Initial monotherapy”, “Early combination therapy”, “Fluctuations and dyskinesia”, and “Parkinsonian tremor”. Furthermore, there is a chapter for special treatment situations, including perioperative management, freezing of gait, and pregnancy and breastfeeding. Conclusion: The recommendations for the pharmacotherapy of motor symptoms of PD have been updated. Newly available drugs have been added, while other drugs (e.g., ergoline dopamine agonists, anticholinergics, budipine) have been removed from the recommendations. © The Author(s) 2024. (Less)
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author
; and
author collaboration
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Guidelines, Parkinson's disease, Pharmacotherapy
in
Journal of Neurology
volume
271
pages
31 pages
publisher
Springer
external identifiers
  • scopus:85206930301
  • pmid:39207521
ISSN
0340-5354
DOI
10.1007/s00415-024-12632-6
language
English
LU publication?
yes
id
4cc0de8e-7339-4e05-b134-bf63d15ec6af
date added to LUP
2025-09-11 09:41:25
date last changed
2025-09-12 03:00:02
@article{4cc0de8e-7339-4e05-b134-bf63d15ec6af,
  abstract     = {{Background and objective: There are multiple pharmacological treatment options for motor symptoms of Parkinson’s disease (PD). These comprise multiple drug classes which are approved for the condition, including levodopa, dopamine agonists, COMT inhibitors, MAO-B inhibitors, NMDA-receptor antagonists, anticholinergics, and others. Some of the drugs are approved for monotherapy and combination therapy while others are only approved as adjunctive therapy to levodopa. Furthermore, treatment for special treatment situations, e.g., rescue medication for off-phases, for tremor, treatment during pregnancy and breast feeding is discussed and recommendations are given with further details. Methods: The recommendations were based on systematic literature reviews, drafted by expert teams, consented in online polls followed by online consensus meetings of the whole German Parkinson’s Guideline Group, and publicly released in November 2023. Results: In the new S2k (i.e., consensus-based) guidelines, the pharmacotherapy of the motor symptoms of PD is discussed in five chapters. These comprise “Parkinson medication”, “Initial monotherapy”, “Early combination therapy”, “Fluctuations and dyskinesia”, and “Parkinsonian tremor”. Furthermore, there is a chapter for special treatment situations, including perioperative management, freezing of gait, and pregnancy and breastfeeding. Conclusion: The recommendations for the pharmacotherapy of motor symptoms of PD have been updated. Newly available drugs have been added, while other drugs (e.g., ergoline dopamine agonists, anticholinergics, budipine) have been removed from the recommendations. © The Author(s) 2024.}},
  author       = {{Höllerhage, M. and Odin, P. and Höglinger, G.U.}},
  issn         = {{0340-5354}},
  keywords     = {{Guidelines; Parkinson's disease; Pharmacotherapy}},
  language     = {{eng}},
  pages        = {{7071--7101}},
  publisher    = {{Springer}},
  series       = {{Journal of Neurology}},
  title        = {{Pharmacotherapy of motor symptoms in early and mid-stage Parkinson’s disease: guideline “Parkinson’s disease” of the German Society of Neurology}},
  url          = {{http://dx.doi.org/10.1007/s00415-024-12632-6}},
  doi          = {{10.1007/s00415-024-12632-6}},
  volume       = {{271}},
  year         = {{2024}},
}