PD Management Update (27 March 1998) The March 1998 issue of the journal Neurology includes a separate 50-page Supplement, edited by two leading U.S. PD researchers, outlining for treatment professionals virtually everything known today about the management of Parkinson's Disease. This is a thorough revision of a similar colloquium published in 1994, bringing in the numerous advances in drugs and treatment strategy that have appeared since then. Containing very little technical language, it looks like a most valuable reference for patients and caregivers, as well as attending professionals. It is organized in the form of an algorithm or decision tree, with several diagrams that are easy to grasp, including two large wall charts that may be used by neurologists to educate their patients in this complex and often confusing disease. One of those is illustrated below. I shall include a citation for future reference in this month's Current Science Reviews, but also here, for any listmembers who may be able to get hold of a copy: Olanow C, Koller, W; An algorithm (decision tree) for the management of Parkinson's disease; Neurology 1998, Vol.50: (Suppl 3):S1 Parkinson's Disease __________|___________________ | | Non-Pharmacologic Pharmacologic | | |---Education Neuroprotection |---Support ?Selegiline |---Exercise | |---Nutrition Functional impairment----| | | | Continue | to monitor ___________|_______ | | | | Yes No-->-| ?Anticholinergics________| ?Amantadine | (Deterioration) ______|________ | | ^ Dose-<--Dopamine Agonists Levodopa-->--^ Dose | |_______________| | | | | |------------->--Combined Therapy-<---------| | Dopamine Agonist + Levodopa | +/- COMT inhibitor | (Adverse events) | See Motor Complications | Unacceptable control with medical therapy | Consider Surgery -- J. R. Bruman (818) 789-3694 3527 Cody Road Sherman Oaks, CA 91403-5013