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The American Academy of Neurology has published a practice parameter on treatment of non-motor symptoms in Parkinson's disease. The parameter summarizes the level of clinical trials evidence for each treatment option, and uses the weight of the evidence to make recommendations for treatment. Treatment of mood and cognition disorders in PD, and treatment of sialorrhea with botulinum toxin, were dealt with in previous practice parameters. The guidelines state: Autonomic symptoms Sildenafil citrate "may be considered" to treat erectile dysfunction in PD patients, based on one study. E-MOVE's report on that study is archived HERE www.mdvu.org/emove/article.asp?ID=410 Data are "insufficient" to recommend any agent for treatment of orthostatic hypotension, other than the currently approved midodrine and Droxidopa. Data are "insufficient" to recommend apomorphine or deep brain stimulation for treatment of urinary incontinence. Randomized trials of anticholinergics in PD are lacking, but "their pharmacologic action and widespread clinical use are consistent with benefit in urinary incontinence." Isosmotic macrogol "possibly improves" constipation, based on one study, and "may be considered." Increased water and dietary fiber intake have also shown clinical benefit. Sleep disorders For patients with excessive daytime sleepiness, modafinil "is effective in improving patients' perception of wakefulness," based on 2 studies, and "should be considered," "but is ineffective in objectively improving EDS as measured by objective tests." E-MOVE's report on one study is archived HERE www.mdvu.org/emove/article.asp?ID=331 Melatonin "is established as effective" for improving perception of sleep quality, based on 2 studies, but there are conflicting data on objective improvements. E-MOVE's report on one study is archived HERE www.mdvu.org/emove/article.asp?ID=526 DBS therapy "possibly improves" sleep quality in advanced PD. Levodopa improved sleep-associated motor symptoms that may contribute to insomnia, but data on objective or subjective improvements on sleep are "insufficient." Levodopa "probably decreases" the frequency of periodic leg movements of sleep, based on 1 study, and "should be considered." Data on use of dopamine agonists for RLS or PLMS are "insufficient." Fatigue Methylphenidate "is possibly useful" for treatment of fatigue in PD, based on 1 study, and "may be considered." Anxiety Data are insufficient for any treatment of anxiety in PD. The mechanism of action and widespread clinical use of anti-anxiety medications in PD are "consistent with benefit." Practice parameter: Treatment of nonmotor symptoms of Parkinson disease. Report of the Quality Standards Subcommittee of the American Academy of Neurology TA Zesiewicz, KL Sullivan, I Arnulf, KR Chaudhauri, JC Morgan, GS Gronseth, J Miyasaki, DJ Iverson, WJ Weiner Neurology 2010;74:924-931 ---------------------------------------------------------------------- To sign-off Parkinsn send a message to: mailto:[log in to unmask] In the body of the message put: signoff parkinsn