Initial drug treatment in Parkinson’s disease

The bottom line First line treatments for Parkinson's disease include levodopa, non-ergot dopamine agonists, and monoamine oxidase B inhibitors Consider starting levodopa treatment in all (except young) patients, especially those with serious motor impairment (because it has greater motor benefits than other drugs) or cognitive impairment (because it has fewer neuropsychiatric complications than dopamine agonists) Monitor for motor complications (dyskinesias, motor fluctuations) and impulsivity and adjust doses accordingly Do not stop treatment abruptly because this may cause malignant hyperthermia (Parkinson hyperpyrexia syndrome) A 69 year old retired bus driver with no medical history of note presented to the outpatients department with a three year history of progressive tremor of the right hand; slowness of movement; and difficulty turning in bed at night, buttoning shirts, and using cutlery.