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AAN: New Parkinson's Disease Treatment Guidelines Issued By Ed Susman, MedPage Today Staff Writer Reviewed by Robert Jasmer, MD; Assistant Professor of Medicine, University of California, San Francisco April 07, 2006 MedPage Today Action Points Doctors should explain to patients that new guidelines found no "neuroprotective" therapies to have any value. Note that the guidelines leave to the art of medicine decisions such as the order of the selection of drugs for treatment. Doctors should screen all Parkinson's patients for depression. Review SAN DIEGO, April 7 - New guidelines for the treatment of Parkinson's disease, issued by the American Academy of Neurology, are more proscriptive than prescriptive. "We did not describe in what order useful drugs for the treatment of Parkinson's disease should be used," said William Weiner, M.D., of the University of Maryland School of Medicine in Baltimore. "That still remains part of the art of medicine." Yet the guidelines, released simultaneously in Neurology and at the AAN meeting here, were quite explicit about agents of neuroprotection -- drugs that can prevent or turn back the disease: There are none, the guidelines said. "These guidelines inform the physician -- as well as patients -- that there is no neuroprotective therapy that has shown any proven value," said Dr. Weiner. "The guidelines demonstrate that nutritional supplementation, for example, do not work." About the only steps that appear to have any value are exercise and physical therapy, he said. The guidelines were divided into four broad areas, with 20 specific recommendations sprinkled through. The broad areas included: Diagnosis and prognosis of new-onset disease; Neuroprotective treatments and alternative therapies; Management of Parkinson's disease with motor fluctuations and dyskinesia; Depression, psychosis, and dementia that are associated with Parkinson's disease. The guidelines, available at the AAN's Web site, replaced recommendations from the academy that have been in effect since 2002, said Dr. Weiner, who discussed the recommendations at a press briefing. "The previous guidelines looked at when patients with Parkinson's disease begin to develop symptoms that are troublesome and require treatment, and what medications should be started," he said. "These guidelines are much different because they offer a much more comprehensive view of Parkinson's disease." He particularly noted that the guidelines specifically addressed treatment issues with individuals who have depression and other psychological comorbidities along with Parkinson's disease. At the briefing, Janis Miyasaki, M.D., of the Movement Disorders Center at Toronto Western Hospital, said that 70% of patients with Parkinson's disease have depression. The new guidelines recommend that clinicians evaluate individuals diagnosed with Parkinson's disease with the Beck Depression Inventory and the Hamilton Depression Rating Scale to pinpoint the extent of Parkinson's-related depression. Tests such as the Mini Mental State Examination and the Cambridge Cognitive Examination should be used to screen for dementia in such patients, Dr. Miyasaki added. The guidelines included the use of new drugs, Comtan (entacapone) and Azilect (rasagiline), and indicated that there is a role in treatment for deep brain stimulation. Rajesh Pahwa, M.D., of the University of Kansas Medical Center in Kansas City, said evidence supports use of Comtan and Azilect to reduce "off" time in patients whose disease has progressed and whose medication provides less reliable amelioration of symptoms. Dr. Pahwa noted that progress in deep-brain stimulation led to an update in the guidelines, which now read: "Deep brain stimulation of the subthalamic nucleus may [help] improve motor function and reduce motor fluctuations, dyskinesia and medication usage." The guidelines said further evidence is required to support deep brain stimulation in other areas of the body. ---------------------------------------------------------------------- To sign-off Parkinsn send a message to: mailto:[log in to unmask] In the body of the message put: signoff parkinsn