Parkinson’s disease: Canadian panel issues updated guidelines

  • CMAJ

  • International Clinical Digest
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Takeaway

  • Comprehensive updated Canadian guidelines provide evidence-based practical guidance on managing Parkinson’s disease.
  • Set of nearly 100 recommendations is intended for physicians, allied health professionals, patients, and families.

Why this matters

 Key results

  • The guidelines note that dementia, even when present early, should not exclude a diagnosis of Parkinson’s disease.
  • Clinicians should not routinely use CT or MRI brain imaging for diagnosis.
  • Patients with Parkinson’s disease on dopaminergic therapy, especially dopamine agonists, should be monitored for the development of impulse control disorders.
  • For managing motor symptoms and fluctuations, advanced therapies such as deep brain stimulation and intrajejunal levodopa-carbidopa gel infusion are now routinely used.
  • Evidence supports benefit from initiation of a routine exercise program early in Parkinson’s disease.
  • Clinicians should consider patients’ palliative care needs and wishes, including possible medical assistance in dying.

Expert comment

  • In a commentary, Veronica Bruno, MD, MPH, and Maria Eliza Thomaz de Freitas, MD, write, “More research is needed to increase the current understanding of Parkinson disease biomarkers for neuroprotective and disease-modifying treatments, and improved therapies for motor and nonmotor symptoms. Until neuroprotective and disease-modifying treatments become available, improvements in the management of motor fluctuations and dyskinesia, such as long-lasting treatments with a reduced adverse effect profile, are also needed.”

Study design

  • Guidelines developed by a multidisciplinary expert panel, with review of new evidence and consideration of recommendations from Scotland, UK, European Union, United States.
  • Topics covered: communication (6 recommendations), diagnosis and progression (16), treatment of motor symptoms (44), treatment of nonmotor features (26), palliative care (5).
  • Funding: Parkinson Canada.

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