Send to

Choose Destination
Mov Disord. 2018 Aug;33(8):1248-1266. doi: 10.1002/mds.27372. Epub 2018 Mar 23.

International Parkinson and movement disorder society evidence-based medicine review: Update on treatments for the motor symptoms of Parkinson's disease.

Author information

Edmund J. Safra Program, Movement Disorder Clinic, Toronto Western Hospital, Toronto, Ontario, Canada.
University of Toronto Department of Medicine, Toronto, Ontario, Canada.
Department of Neurology and Karl Landsteiner Institute for Neuroimmunological and Neurodegenerative Disorders, Danube Hospital, Vienna, Austria.
Division of Neurology and the Mah Pooi Soo & Tan Chin Nam Centre for Parkinson's & Related Disorders, University of Malaya, Kuala Lumpur, Malaysia.
Rush University Medical Center, Chicago, Illinois, USA.
Jesse Brown VA Medical Center, Chicago, Illinois, USA.
Department of Neurology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
Department of Neurology, Medical University Innsbruck, Innsbruck, Austria.
Department of Neurology, Santa Maria Hospital, Instituto de Medicina Molecular, University of Lisbon, Lisbon, Portugal.
Cure Huntington's Disease Initiative (CHDI) Management/CHDI Foundation, Princeton, NJ, USA.
Instituto de Medicina Molecular, University of Lisbon, Lisbon, Portugal.

Erratum in



The objective of this review was to update evidence-based medicine recommendations for treating motor symptoms of Parkinson's disease (PD).


The Movement Disorder Society Evidence-Based Medicine Committee recommendations for treatments of PD were first published in 2002 and updated in 2011, and we continued the review to December 31, 2016.


Level I studies of interventions for motor symptoms were reviewed. Criteria for inclusion and quality scoring were as previously reported. Five clinical indications were considered, and conclusions regarding the implications for clinical practice are reported.


A total of 143 new studies qualified. There are no clinically useful interventions to prevent/delay disease progression. For monotherapy of early PD, nonergot dopamine agonists, oral levodopa preparations, selegiline, and rasagiline are clinically useful. For adjunct therapy in early/stable PD, nonergot dopamine agonists, rasagiline, and zonisamide are clinically useful. For adjunct therapy in optimized PD for general or specific motor symptoms including gait, rivastigmine is possibly useful and physiotherapy is clinically useful; exercise-based movement strategy training and formalized patterned exercises are possibly useful. There are no new studies and no changes in the conclusions for the prevention/delay of motor complications. For treating motor fluctuations, most nonergot dopamine agonists, pergolide, levodopa ER, levodopa intestinal infusion, entacapone, opicapone, rasagiline, zonisamide, safinamide, and bilateral STN and GPi DBS are clinically useful. For dyskinesia, amantadine, clozapine, and bilateral STN DBS and GPi DBS are clinically useful.


The options for treating PD symptoms continues to expand. These recommendations allow the treating physician to determine which intervention to recommend to an individual patient. © 2018 International Parkinson and Movement Disorder Society.


Parkinson's disease; amantadine; anticholinergics; catechol-O-methyl transferase inhibitors; clozapine; complementary therapies; deep brain stimulation; dopamine agonists; evidence-based medicine; exercise; levodopa; monoamine oxidase inhibitors; neurosurgery; occupational therapy; physical therapy; randomized controlled trial; speech therapy


Supplemental Content

Full text links

Icon for Wiley
Loading ...
Support Center