Current and investigational non-dopaminergic agents for management of motor symptoms (including motor complications) in Parkinson’s disease

ABSTRACT

Introduction: Parkinson’s disease is characterized by a heterogeneous combination of motor and non motor symptoms. The nigrostriatal dopamine deficit is one of its essential pathophysiologic features.

Areas covered: This invited narrative review provides an overlook over current available and future promising non dopaminergic therapeutics to modulate altered dopaminergic neurotransmission in Parkinson’s disease. Current research strategies aim to proof clinical efficacy by amelioration of motor symptoms and preponderant levodopa related movement fluctuations. These so-called motor complications are characterized by involuntary movements as a result of an overstimulation of the nigrostriatal dopaminergic system or by temporary recurrence of motor symptoms, when beneficial effects of dopamine substituting drugs vane.

Expert opinion: Non dopaminergic modulation of dopamine replacement is currently mostly investigated in well defined and selected patients with motor complications to get approval. However, the world of daily maintenance of patients with its individually adapted, so-called personalised, therapy will determine the real value of these therapeutics. Here the clinical experience of the treating neurologists and the courage to use unconventional drug combinations are essential preconditions for successful treatments of motor and associated non motor complications in cooperation with the patients and their care giving surroundings.

KEYWORDS:

• Non-dopaminergic drugs
• adenosine
• glutamate
• pharmacotherapy
• Parkinson’s disease

Article highlights

• The term idiopathic Parkinson’s disease represents a superordinate concept for various each other more or less resembling neuropsychiatric disorders.

• Chronic and heterogeneous neuronal dying asks for an individually adapted, careful drug dosing and combination of therapeuties during the whole course of the disease.

• Non dopaminergic therapeuties modulate dopamine substitution to enable amelioration of motor complications.

• Clinicians, patients and caregivers determine the value of these therapeuties in the real world of daily maintenance of patients with Parkinson’s disease.

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Declaration of interest

T Müller has nothing to disclose in relation with this paper, he has served as a Principle Investigator and advisor to Bial, Zambon, Merck Serono, Lundbeck and Biotie. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed

Additional information

Funding

This paper was not funded.