AAN updates recommendations for the treatment of early Parkinson’s disease

The American Academy of Neurology (AAN) has issued updated guidelines for initiating dopaminergic therapy for motor symptoms in early Parkinson’s disease.

According to the guidelines, people with early-stage Parkinson’s should be counseled about the benefits and risks of initiating treatment with levodopa, dopamine agonists, and monoamine oxidase B (MAO-B) inhibitors.

Initial levodopa treatment was found to be more beneficial for motor symptoms when compared to dopamine agonists or MAO-B inhibitors. While levodopa was more likely to induce dyskinesia than dopamine agonists during the first 5 years of treatment, the prevalence of severe or disabling dyskinesia was found to be low during this time. To optimize benefits and reduce the risk of dyskinesia, the lowest effective dose of levodopa should be prescribed.

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Dopamine agonist treatment was associated with a higher risk of impulse control disorders (e.g., gambling addiction, eating, shopping, sexual activity, hallucinations) compared to levodopa. There was also a higher risk of excessive daytime sleepiness associated with the use of dopamine agonists.

People treated with dopamine agonists or MAO-B inhibitors were more likely to discontinue treatment due to side effects compared to levodopa. In addition, patients treated with MAO-B inhibitor monotherapy were more likely to require additional therapy within 2 to 3 years.

“We carefully reviewed the available research on the effectiveness and potential risks of drugs used to treat motor symptoms in people with early-stage Parkinson’s disease and determined that levodopa is usually the best first line treatment for these symptoms,” said Tamara Pringsheim, MD, MSc., Lead author of the guideline, University of Calgary, Alberta, Canada, and Fellow of the American Academy of Neurology. “Still, levodopa and other drugs have side effects, so it is important that a newly diagnosed Parkinson’s disease discuss all options with their neurologist before deciding on the best treatment plan.”


  1. AAN publishes guidelines for treating early Parkinson’s disease. Press release. American Academy of Neurology. Accessed November 16, 2021.
  2. T. Pringsheim, GS Day, DB Smith et al. Dopaminergic Therapy for Motor Symptoms in Early Parkinson’s Disease Summary of Practice Guidelines: A Report from the AAN Guidelines Subcommittee. Neurology. Published online November 15, 2021. doi: 10.1212 / WNL.0000000000012868

This article originally appeared on MPR


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