Management of Motor Complications in Parkinson Disease: Current and Emerging Therapies

Motor fluctuations and dyskinesias are common motor complications that manifest within the first few years from the initiation of therapy in patients with Parkinson disease. These complications negatively affect the quality of life and represent an important source of disability. A growing number of therapeutic options including treatments aimed at prolonging the efficacy of levodopa (eg, selective monoamine oxidase-B inhibitors and catechol-O-methyltransferase inhibitors), administration of longer-acting dopamine agonists (eg, rotigotine, sustained-release ropinirole), and continuous administration of intraduodenal levodopa exist or will soon become available. Patients who maintain a good response to levodopa but continue to experience disabling motor complications despite the best medical management may benefit from a regimen of subcutaneous apomorphine, ideally delivered by a subcutaneous pump, or deep-brain stimulation of the subthalamic nucleus or internal portion of the pallidum. Emerging therapies for motor complications are expected to further enhance continuous (physiologic) delivery of dopaminergic drugs and extend the reach of therapies beyond the dopaminergic system to influence not only the motor but also the vast range of nonmotor complications of this multisystemic disease.