American Academy of Neurology Issues Guidelines for Treating Motor Symptoms


The guidance updates the recommendations on dopaminergic medications that were published in 2002 on the initiation treatment for Parkinson disease.

The American Academy of Neurology (AAN) has issued guidelines for treating movement symptoms, known as motor symptoms, for individuals with early Parkinson disease.

The guidelines update the recommendations on dopaminergic medications that were published in 2002 on the initiation treatment for Parkinson disease.

“We carefully reviewed the available research on the effectiveness and possible risks of medications to treat motor symptoms in people with early Parkinson disease and found that levodopa is usually the best first treatment for these symptoms,” Tamara Pringsheim, MD, MSc, of the University of Calgary and a fellow of the AAN, said in a statement.

The new guidelines recommend that health care providers should counsel individuals with early Parkinson disease on the benefits and risks of 3 initial therapy options: dopamine agonists, which mimic the effects of dopamine; levodopa, a drug that is converted into dopamine in the brain; and monoamine oxidase B (MAO-B) inhibitors, which prevent MAO-B enzymes from breaking down dopamine.

The guidelines also state that treatment with levodopa provides superior benefits at reducing motor symptoms than the other options.

Levodopa is more likely than initial treatment with dopamine agonists to cause dyskinesia during the first 5 years of treatment, but the prevalence was low during this timeframe.

The guidelines recommend that health care providers prescribe the lowest effective dose to minimize the risk of dyskinesia and optimize benefits.

Dopamine agonists are more likely to cause impulse-control disorders, such as compulsive gambling, eating, sexual activity or shopping, as well as hallucinations. They can also have a greater risk of causing excessive daytime sleepiness.

Individuals are also more likely to stop their treatment because of adverse effects when taking dopamine agonists and MAO-B inhibitors than levodopa.

Individuals who take MAO-B inhibitors are also more likely to require additional therapy within 2 to 3 years.

The guidelines were published in the online issue of Neurology.


AAN issues guideline for treatment of early Parkinson’s disease. EurekAlert. News release. November 15, 2021. Accessed November 16, 2021.

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