Pharmacotherapy of motor symptoms in early and mid-stage Parkinson's disease: guideline "Parkinson's disease" of the German Society of Neurology.

Autor: Höllerhage M; Department of Neurology, Hannover Medical School, Hannover, Germany., Becktepe J; Department of Neurology, Christian-Albrechts-University, Kiel, Germany., Classen J; Department of Neurology, Leipzig University Medical Center, Leipzig, Germany., Deuschl G; Department of Neurology, Christian-Albrechts-University, Kiel, Germany., Ebersbach G; Movement Disorders Hospital, Beelitz-Heilstätten, Germany., Hopfner F; Department of Neurology with Friedrich Baur Institute, LMU University Hospital, Ludwig-Maximilians-Universität (LMU) München, Marchioninistr. 15, 81377, Munich, Germany., Lingor P; School of Medicine and Health, Department of Neurology, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany.; Munich Cluster for Systems Neurology (SyNergy), Munich, Germany.; German Center for Neurodegenerative Diseases (DZNE), Munich, Germany., Löhle M; Department of Neurology, University of Rostock, 18051, Rostock, Germany.; Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE) Rostock/Greifswald, Rostock, Germany., Maaß S; German Center for Neurodegenerative Diseases (DZNE), Munich, Germany., Pötter-Nerger M; Department of Neurology, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany., Odin P; Division of Neurology, Lund University, Lund, Sweden.; Department of Neurology, Skåne University Hospital, Lund, Sweden., Woitalla D; Department of Neurology, St. Josef-Hospital, Katholische Kliniken Ruhrhalbinsel, Contilia Gruppe, Essen, Germany., Trenkwalder C; Paracelsus-Elena-Klinik, Kassel, Germany.; Department of Neurosurgery, University Medical Center, Göttingen, Germany., Höglinger GU; Department of Neurology with Friedrich Baur Institute, LMU University Hospital, Ludwig-Maximilians-Universität (LMU) München, Marchioninistr. 15, 81377, Munich, Germany. Guenter.Hoeglinger@med.uni-muenchen.de.; Munich Cluster for Systems Neurology (SyNergy), Munich, Germany. Guenter.Hoeglinger@med.uni-muenchen.de.; German Center for Neurodegenerative Diseases (DZNE), Munich, Germany. Guenter.Hoeglinger@med.uni-muenchen.de.
Jazyk: angličtina
Zdroj: Journal of neurology [J Neurol] 2024 Nov; Vol. 271 (11), pp. 7071-7101. Date of Electronic Publication: 2024 Aug 29.
DOI: 10.1007/s00415-024-12632-6
Abstrakt: 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.
Competing Interests: Declarations Conflicts of interest Jos Becktepe served as a consultant for Jazz Pharmaceuticals and Neuraxpharm; received honoraria for scientific presentations from Ipsen; received research support from Stratmann; Günther Deuschl served as a consultant for Boston Scientific, Cavion and Insightec; received publication royalties from Thieme; received funding from the German Research Council (SFB 1261, T1) and private foundations. Georg Ebersbach served as a consultant for AbbVie, BIAL, Desitin, STADAa, ESTEVE, Neuraxpharm, Boehringer; received honoraria for scientific presentations from AbbVie, BIAL, Britannia, Desitin, ESTEVE, Licher, STADA, Zambon; received publication royalties from Kohlhammer, Thieme, and Springer. Matthias Höllerhage served as a consultant for AbbVie; received honoraria for scientific presentations from AbbVie; received publication royalties from Thieme. Günter Höglinger has ongoing research collaborations with Roche, UCB, AbbVie; served as a consultant for Abbvie, Alzprotect, Amylyx, Aprinoia, Asceneuron, Bayer, Bial, Biogen, Biohaven, Epidarex, Ferrer, Kyowa Kirin, Lundbeck, Novartis, Retrotope, Roche, Sanofi, Servier, Takeda, Teva, UCB; received honoraria for scientific presentations from AbbVie, Bayer, Bial, Biogen, Bristol Myers Squibb, Esteve, Kyowa Kirin, Pfizer, Roche, Teva, UCB, Zambon. received publication royalties from Academic Press, Kohlhammer, and Thieme. Dirk Woitalla served as a consultant for AbbVie, Bial, Esteve, StadaPharm, Zambone; received honoraria for scientific presentations from AbbVie, Daiichi, Desitin, Esteve, UCB, Zambone. All other authors declared no conflict of interest.
(© 2024. The Author(s).)
Databáze: MEDLINE
Externí odkaz: