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Título: Update on Treatments for Parkinson's Disease Motor Fluctuations – An International Parkinson and Movement Disorder Society Evidence‐Based Medicine Review
Autor: 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. 
Palabras clave: ENFERMEDAD DE PARKINSONDISCAPACIDAD MOTORATRATAMIENTO FARMACOLOGICO
Fecha de publicación: 2025
Editorial: International Parkinson and Movement Disorder Society
Resumen: 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.
URI: https://repositorio.uca.edu.ar/handle/123456789/20085
ISSN: 1531-8257
0885-3185
DOI: 10.1002/mds.30162
Derechos: Atribución-NoComercial-CompartirIgual 4.0 Internacional
Fuente: Movement Disorders. 40(5), 2025.
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