Management Strategies for Parkinson's Disease Syndromes

Management of Parkinson’s disease syndromes encompasses a spectrum of interventions tailored to disease stage, symptom profile and individual patient needs. In early stages, monotherapy with levodopa or dopamine agonists often suffices to control motor symptoms. As the condition advances, combination pharmacotherapy – including monoamine oxidase-B inhibitors, catechol-O-methyltransferase inhibitors and amantadine – aims to smooth motor fluctuations and reduce dyskinesias. Non-pharmacological measures such as physiotherapy, occupational therapy and speech and language therapy play a crucial role in maintaining function and quality of life. Device-aided therapies, notably deep brain stimulation and continuous infusion of levodopa-carbidopa intestinal gel or apomorphine, are reserved for patients with refractory motor complications. Equally important is the recognition and rapid management of acute syndromes – for example, akinetic crisis, dopamine agonist withdrawal syndrome and dyskinesia-hyperpyrexia syndrome – which require diagnostic vigilance and prompt adjustment of dopaminergic therapy alongside supportive care. An integrated, multidisciplinary approach underpins optimal outcomes and addresses both motor and non-motor manifestations, emphasising patient education, caregiver support and personalised treatment algorithms.

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Management Strategies for Parkinson's Disease Syndromes publication trend

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Technical terms

Levodopa: A precursor of dopamine used to replenish striatal dopamine and improve motor function.

Dopamine agonists: Medications that directly stimulate dopamine receptors to alleviate motor symptoms.

Deep brain stimulation (DBS): A surgical therapy delivering electrical pulses to basal ganglia nuclei to reduce motor fluctuations.

Akinetic crisis: An acute, severe, levodopa-resistant exacerbation of rigidity and akinesia often triggered by medication withdrawal or systemic stress.

Dyskinesia-hyperpyrexia syndrome: A life-threatening complication marked by excessive involuntary movements and high fever, typically in advanced disease.

DAT-SPECT: Dopamine transporter single-photon emission computed tomography, an imaging biomarker of presynaptic dopamine neuron integrity.

References

1. Akinetic crisis and withdrawal syndromes: guideline “Parkinson’s disease” of the German Society of Neurology. Journal of Neurology (2024).
2. The akinetic crisis in Parkinson´s disease- the upper end of a spectrum of subacute akinetic states. Journal of Neural Transmission (2024).
3. A Stage-Based Approach to Therapy in Parkinson’s Disease. Biomolecules (2019).
4. Dyskinesia-hyperpyrexia syndrome in Parkinson’s disease: a systematic review. Clinical Autonomic Research (2021).