Treatment of Parkinson disease, time and dosage: "does simple dosage facilitate compliance and therapeutic goals?"

Abstract

Current available treatment for Parkinson disease has many drawbacks: single action on the nigrostriatal pathway, no halt of disease progression, pulsatile dopaminergic stimulation, complex treatment regimens, and motor complications. Compliance with treatment may be irregular in a variable number of patients. Factors such as age, education, complexity of posology, stage of disease, disease comprehension, cognitive function, or family support significantly influence compliance either in a positive or negative way. The consequences of noncompliance include withdrawal symptoms, increase in number of admissions, or, in severe cases, hyperthermia syndrome secondary to levodopa deficit in the case of infradose. In situations of overdose, dyskinesia or psychiatric complications may arise. The ideal treatment should have the potency of levodopa but not its side effects, act on striatal D2 receptors in a continuous way with a single dose and have low potential of addiction. Thus far, simple regimens are only applicable in early stages.