Drug treatment of early Parkinson's disease, one table summary

*Only for medical professionals to read for reference early PD drug selection, remember these two sentences! Drug therapy is the main treatment for Parkinson's disease (PD), especially for patients with early PD.

As World Parkinson's Disease Day is approaching, let us follow the "Guidelines for the Treatment of Parkinson's Disease in China (Fourth Edition)" released in December 2020 [1] to learn how to start drug treatment for PD patients.

Principles of Treatment Firstly, mastering drug therapy is the main treatment for PD, but before learning specific early PD medications, please have an overall grasp of the concept of PD treatment.

The treatment principles of PD include comprehensive treatment, multidisciplinary treatment and full-course management.

Here is a picture to summarize the principles of PD treatment (Figure 1).

Figure 1: Principles of PD treatment Does early PD need medication? The answer is yes.

The distinction between early PD and mid-late PD is determined based on the Hoehn-Yahr classification.

Hoehn-Yahr grades 1.
0-2.
5 belong to early PD, while Hoehn-Yahr grades 3-5 belong to mid-late PD.

After the diagnosis of PD, if the grade is lower, many patients may wish to not use medication first.

At this time, it is necessary to clearly inform the patient that, like most diseases, PD requires early diagnosis and early treatment.

Early treatment may obtain disease modification treatment, that is, through treatment to achieve the purpose of delaying the progression of the disease, rather than simply improving symptoms.

One table summary: There are 6 categories of anti-Parkinson drugs for early PD treatment, including (1) compound levodopa; (2) dopamine receptor agonists (DAs); (3) monoamine oxidase type B inhibitors (Monoamine oxidase type B inhibitor, MAO-BI); (4) Catechol-O-methyltransferase inhibitor (COMTI); (5) Anticholinergics; (6) Amantadine.

Here is only a reminder of category (5), anticholinergic drugs: mainly used for patients with tremor; because anticholinergic drugs may cause cognitive impairment, patients over 60 years old should not use or use them as little as possible.

Here is a table to summarize the representative drugs of each type of drug and the precautions for medication.

Figure 2: A table summarizing how early PD medications can start early PD medications.
For PD patients, after a clear diagnosis, the next step is to choose appropriate medications for the patients.

"Chinese Parkinson's Disease Treatment Guidelines (Fourth Edition)" gives a detailed drug selection plan.

Here, in order to facilitate clinical application, according to the guidelines, we summarize and summarize the selection of early PD drug treatment, which is convenient for everyone to understand and remember.

First of all, the patients are classified, that is, PD can be divided into early onset and late onset.

Early-onset PD is defined as the age of onset ≤ 50 years old [2].

Early-onset PD accounts for 5%-10% of the total number of PD [2], and it is necessary to consider whether it is accompanied by mental decline when choosing drugs.

It can be seen that patients with late-onset PD and early-onset PD with mental decline accounted for most of the proportion.

When choosing drugs, we choose according to the patient's classification.

In most patients, the first-choice anti-PD drug is compound levodopa, including late-onset PD and early-onset PD with mental decline.

As the patient's condition changes, DAs, MAO-BI and COMTI are added.

For a small number of patients, the first choice of anti-PD drugs is determined based on the characteristics of the patient's symptoms, mainly early-onset PD without mental decline.

For the specific drug selection process, the guide has drawn a detailed flow chart (Figure 3).

It should be noted that if the patient's motor symptoms need to be significantly improved, then choose compound levodopa or entacapone dipopa treatment; or use a small dose of non-ergot DAs or MAO-BI, and a small dose of combined levodopa Dopa.

Figure 3: PD drug treatment process.
Here, we also summarized the early PD medication table for everyone to quickly refer to (Figure 4).

Figure 4: Early PD medication selection.
Finally, summarize the essence of this article and hope to help your clinical practice: 1.
PD treatment is comprehensive and long-term, and drug therapy is the main method.
Anti-PD drugs should be used in the early stage.

2.
Early PD drug selection, remember two sentences (1) For most patients, the first anti-PD drug is compound levodopa, whether it is late-onset PD or early-onset PD with mental decline.

(2) For a small number of patients, the first choice of anti-PD drugs is determined based on the characteristics of the patient's symptoms, mainly early-onset PD without mental decline.

April 11, 2021 is the 25th World Parkinson’s Day.
In order to enable all doctors to better understand the diagnosis and treatment of PD and the latest progress of the disease, we hereby invite 5 experts from the Department of Neurology, Xuanwu Hospital, Capital Medical University Come to the special lecture.

The content of this series of courses is concise and clear, vivid and specific, and should not be missed.

References: [1] Chinese Parkinson's Disease Treatment Guidelines (Fourth Edition) [J].
Chinese Journal of Neurology, 2020, 53 (12): 973-986.
[2] Early-onset Parkinson's disease diagnosis and treatment China Expert consensus[J].
Chinese Journal of Neuromedicine, 2021, 20(2): 109-116.