Update on Treatments for Parkinson's Disease Motor Fluctuations – An International Parkinson and Movement Disorder Society Evidence‐Based Medicine Review

• Autores: de Bie, Rob M.A.; Katzenschlager, Regina; Swinnen, Bart E.K.S.; Peball, Marina; Lim, Shen-Yang; Mestre, Tiago A.; Pérez Lloret, Santiago; Coelho, Miguel; Aquino, Camila; Tan, Ai Huey; Bruno, Veronica; Dijk, Joke M.; Heim, Beatrice; Lin, Chin-Hsien; Azevedo Kauppila, Linda; Litvan, Irene; Spijker, René; Seppi, Klaus; Costa, João; Sampaio, Cristina; Fox, Susan H.; Silverdale, Monty A.
• Año de publicación: 2025
• Idioma: inglés
• Tipo de recurso: artículo
• Fuente: Movement Disorders. 40(5), 2025.
• Materia: ENFERMEDAD DE PARKINSON; DISCAPACIDAD MOTORA; TRATAMIENTO FARMACOLOGICO
• Institución: Pontificia Universidad Católica Argentina

Fil: de Bie, Rob M.A. Universidad de Ámsterdam; Países Bajos
Fil: Katzenschlager, Regina. Klinik Donaustadt; Austria
Fil: Swinnen, Bart E.K.S. Hospital Universitario UZ Leuven; Bélgica
Fil: Peball, Marina. Universidad Médica de Innsbruck; Austria
Fil: Lim, Shen-Yang. Universidad de Malaya; Malasia
Fil: Mestre, Tiago A. Universidad de Ottawa; Canadá
Fil: Perez Lloret, Santiago. Pontificia Universidad Católica Argentina; Argentina
Fil: Perez Lloret, Santiago. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina
Fil: Perez Lloret, Santiago. Universidad de Buenos Aires; Argentina
Fil: Coelho, Miguel. Universidad de Lisboa; Portugal
Fil: Aquino, Camila. Universidad de Calgary; Canadá
Fil: Tan, Ai Huey. Universidad de Malaya; Malasia
Fil: Bruno, Veronica. Universidad de Calgary; Canadá
Fil: Dijk, Joke M. Universidad de Ámsterdam; Países Bajos
Fil: Heim, Beatrice. Universidad Médica de Innsbruck; Austria
Fil: Lin, Chin-Hsien. Hospital de la Universidad Nacional de Taiwán; Taiwán
Fil: Azevedo Kauppila, Linda. Campus Neurológico, Torres Vedras; Portugal
Fil: Litvan, Irene. Universidad de California; Estados Unidos
Fil: Spijker, René. Universidad de Ámsterdam; Países Bajos
Fil: Seppi, Klaus. Universidad Médica de Innsbruck; Austria
Fil: Seppi, Klaus. Hospital Kufstein; Austria
Fil: Costa, João. Universidad de Lisboa; Portugal
Fil: Sampaio, Cristina. CHDI Management; Estados Unidos
Fil: Sampaio, Cristina. Universidad de Lisboa; Portugal
Fil: Fox, Susan H. Universidad de Toronto; Canadá
Fil: Silverdale, Monty A. Universidad de Manchester; Reino Unido
Objective: To update evidence-based medicine recommendations for treating motor fluctuations of Parkinson's disease (PD). Background: The International Parkinson and Movement Disorder Society (MDS) Evidence Based Medicine in Movement Disorders Committee recommendations for the treatments of PD were first published in 2002 and regularly updated. The current review uses a new methodology, including the Cochrane Risk of Bias tool and a modified version of GRADE (Grading of Recommendations, Assessment, Development, and Evaluations). Methods: On January 1, 2023, a literature search was conducted without date limit in the MEDLINE, Embase, and Cochrane databases using the following search terms: Parkinson disease, levodopa and, for the Embase database, randomized controlled trial (RCT). The inclusion criteria for studies were: patients with PD, on oral levodopa therapy, experiencing motor fluctuations, investigating an intervention that was (commercially) available in at least one country, study design RCT, and with a follow-up duration of at least 3 months. Results: A total of 102 studies were included. Levodopa extended release, pramipexole immediate release and extended release, ropinirole immediate release, rotigotine, opicapone, safinamide, and bilateral subthalamic nucleus deep brain stimulation (DBS) were assessed as efficacious, and continuous intestinal levodopa infusion, continuous subcutaneous levodopa, continuous subcutaneous apomorphine, ropinirole prolonged release, ropinirole patch, entacapone, rasagiline, istradefylline, amantadine extended release, zonisamide, bilateral globus pallidus DBS, and pallidotomy were assessed as likely efficacious for the treatment of motor fluctuations in people with PD who are already being treated with levodopa. Conclusions: There are several treatment options that can improve motor fluctuations in PD. These recommendations will assist physicians and patients in determining which intervention to use. © 2025 The Author(s). Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.