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From: Pharmacological Treatment of Parkinson DiseaseA Review
JAMA. 2014;311(16):1670-1683. doi:10.1001/jama.2014.3654
Figure Legend:
Schematic Illustration of Neurologic Pathways Affected in Parkinson Disease and Sites of Action of Medications for the Treatment of
Motor SymptomsAvailable medications to treat the motor symptoms of Parkinson disease act on complex neurologic interactions in
the striatum that affect motor activity. Dopaminergic afferents from the substantia nigra, glutamatergic afferents from the cerebral
cortex and thalamus, and cholinergic striatal interneurons all converge to influence the activity of the main efferent neurons of the
striatum, the medium spiny GABAergic neurons.Copyright
Levodopa
is transported
from the peripheral circulation across the blood-brain
© 2014
American Medical
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of and
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barrier
is converted
centrally to dopamine, replacing
the
neurotransmitter
Association. All rights reserved.deficient in Parkinson disease. Outside the bloodbrain barrier, in the peripheral circulation, dopamine decarboxylase inhibitors (DDCIs) block the conversion of levodopa to
From: Pharmacological Treatment of Parkinson DiseaseA Review
JAMA. 2014;311(16):1670-1683. doi:10.1001/jama.2014.3654
Figure Legend:
Algorithm for the Treatment of Parkinson Disease With Tremor-Dominant Motor SymptomsaAnticholinergic use is anecdotal and not
supported by randomized clinical trials.bIf the patient experiences inadequate symptom control while on current therapy and there
was more than 1 treatment option in the previous step, go back to previous step and try an alternate treatment option. If all options
in the previous step fail to provide adequate symptom control, move to the next step in the algorithm. cSuboptimal benefit is defined
as improvement in parkinsonian symptoms following
initiation
of therapy,
the patient still experiences a bothersome or disabling
Copyright
© 2014
Americanbut
Medical
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5/12/2017
degree
of symptoms
either continuously or intermittently.
In
these
cases,
increase
the dose of current medication if the patient is not
Association. All rights reserved.
receiving a maximal dose or add another medication. If benefit is absent, stop the current medication and try another. dSurgery for
From: Pharmacological Treatment of Parkinson DiseaseA Review
JAMA. 2014;311(16):1670-1683. doi:10.1001/jama.2014.3654
Figure Legend:
Algorithm for the Treatment of Parkinson Disease With Predominant Bradykinesia and Impaired Dexterity aSuboptimal benefit is
defined as improvement in parkinsonian symptoms following initiation of therapy, but the patient still experiences a bothersome or
disabling degree of symptoms either continuously or intermittently. In these cases, increase the dose of current medication if the
patient is not receiving a maximal dose or add another medication. If benefit is absent, stop the current medication and try
another.bIf the patient experiences inadequate symptom
on current
Copyrightcontrol
© 2014 while
American
Medicaltherapy and there was more than 1 treatment
Date
of in
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5/12/2017
option
the previous
step, go back to previous step
and
try
an
alternate
treatment
option. If all options in the previous step fail to
Association. All rights reserved.
provide adequate symptom control, move to the next step in the algorithm.
From: Pharmacological Treatment of Parkinson DiseaseA Review
JAMA. 2014;311(16):1670-1683. doi:10.1001/jama.2014.3654
Figure Legend:
Algorithm for the Treatment of Parkinson Disease With Predominant Postural Instability and Gait Impairment aSuboptimal benefit is
defined as improvement in parkinsonian symptoms following initiation of therapy, but the patient still experiences a bothersome or
disabling degree of symptoms either continuously or intermittently. In these cases, increase the dose of current medication if the
patient is not receiving a maximal dose or add another medication. If benefit is absent, stop the current medication and try
another.bIf the patient experiences inadequate symptom
on current
Copyrightcontrol
© 2014 while
American
Medicaltherapy and there was more than 1 treatment
Date
of in
download:
5/12/2017
option
the previous
step, go back to previous step
and
try
an
alternate
treatment
option. If all options in the previous step fail to
Association. All rights reserved.
c
provide adequate symptom control, move to the next step in the algorithm. Persistent ambulatory problems including freezing,