REATMENT OF NON-MOTOR SYMPTOMS OF PARKINSON’S DISEASE

Abstract

Non -motor manifestations are present in the majority of patients with Parkinson’s Disease (PD) covering a wide spectrum of symptoms, starting even before the onset of motor deficits and evolving through the patient’s lifespan. Non-motor manifestations include neuropsychiatric symptoms, sleep and wakefulness disorders, autonomic system disturbance, fatigue, apathy, drooling, gastrointestinal and urinary dysfunction etc. Treatment of these multiple and heterogeneous symptoms can be challenging and sometimes quite disappointing. There is a number of high quality studies addressing the problem and offering evidence-based standards for treatment for certain symptoms, but a significant number of non-motor manifestations are empirically treated. Recently the International Parkinson and Movement Disorder Society (MDS) has authorized an Evidence-Based Medicine (EBM) Committee to publish recommendations on treating PD non-motor symptoms. According to their findings, there are clinically useful or possibly useful interventions for the treatment of depression, impulse control and related disorders, apathy, dementia, psychosis, insomnia, daytime sleepiness, orthostatic hypotension, fatigue, gastrointestinal dysfunction, drooling, urinary dysfunction and erectile dysfunction. Since there are no randomized controlled trials that meet EBM criteria for the treatment of anxiety disorders, rapid eye movement sleep behavior disorder, excessive sweating, impaired olfaction, or ophthalmologic dysfunction, no EBM interventions can be proposed for the present time for these disorders.
Taking into consideration the widespread occurrence of non-motor manifestations and the high impact on the burden of the disease and quality of life of PD patients, we conclude that there is an urgent need for more controlled randomized clinical trials, that will support robust guidelines for the treatment of non-motor symptoms in PD in the future.