Article 4

Abstract

Kim Bero, MS, RKT Kinesiotherapist Physical Medicine and Rehabilitation Service James A. Haley Veterans’ Hospital Tampa, Florida PARKINSON’S DISEASE (PD) was first described as “shaking palsy” by James Parkinson in 1817. Currently, this debilitating neurodegenerative disorder affects over 1 million people in North America. The primary treatment of PD is drug therapy. Levodopa has remained the gold standard for drug management of PD. The appropriate time to initiate levodopa therapy is controversial, as long-term use of levodopa is associated with adverse reactions. Development of newer agents such as sustained-release levodopa, direct-acting dopamine agonists, monoamine oxidase type B (MAO-B) inhibitors, and cathecholO-methyltransferase (COMT) inhibitors has provided new options to improve symptoms and quality of life while minimizing adverse effects. Monotherapy, or use of a single medication, may alleviate symptoms in early stages of the disease. However, as the disease progresses, maintaining physical function and minimizing adverse effects often require multiple medications. Optimal medication management is an ongoing process of drug selection and dosage titra-