Introduction and current guidance
A NICE guideline on Parkinson's disease was published in June 2006. An update of this guideline is in progress and publication is expected in April 2017. The guideline describes Parkinson's disease as a progressive neurodegenerative condition resulting from the death of dopamine-containing cells of the substantia nigra region of the brain.
As Parkinson's disease progresses, most people will develop motor complications and will eventually need levodopa therapy. During the course of the disease motor fluctuations and dyskinesias occur, which may be related to long-term levodopa use or disease progression, or both. Adjuvant treatments may also be needed for people who are not adequately controlled on levodopa alone, with the aim of reducing motor complications and improving quality of life. These include dopamine agonists, monoamine oxidase‑B (MAO‑B) inhibitors and catechol-O-methyl transferase (COMT) inhibitors.
The NICE guideline states that it is not possible to identify a universal first-choice adjuvant treatment for people with later Parkinson's disease. The choice of adjuvant medicine first prescribed should take into account:
clinical and lifestyle characteristics
patient preference, after the patient has been informed of the short- and long-term benefits and drawbacks of the classes of medicines.
It recommends that COMT inhibitors may be used to reduce motor fluctuations in people with later Parkinson's disease.