General Approach to Treatment

The treatment of PD is categorized into three phases:

• Lifestyle changes, nutrition, and exercise

• Pharmacologic intervention, primarily with drugs that enhance dopamine concentrations

• Surgical treatments for those who fail pharmacologic interventions

The initial therapeutic modality selected depends in part on the patient's age, risk of psychiatric adverse effects, degree of physical impairment, and one's school of thought on the best time to initiate therapy. The 2002 American Academy of Neurology guidelines18 and 2006 European National Institute for Health and Clinical Excellence guidelines (http://www.nice.org.uk/nicemedia/pdf/cg035fullguideline.pdj) suggest that symptomatic treatment should be delayed until the patient experiences functional disability. Preliminary data, however, suggest that earlier treatment may delay the progression of disease. Trials are in progress to compare different classes of PD drugs to determine which drug class is best for initial therapy and which agent is best in various situations.9

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