- 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
- New evidence has emerged since guidelines were first issued in 2012.
- 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.
- 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.”
- 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.