16 March 2010
Zesiewicz TA, Sullivan KL, Arnulf I, Chaudhuri KR, Morgan JC, Gronseth GS, Miyasaki J, Iverson DJ, Weiner WJ
Objective:
Nonmotor symptoms (sleep dysfunction, sensory symptoms, autonomic
dysfunction, mood disorders, and cognitive abnormalities)
in Parkinson disease (PD) are a major cause of
morbidity, yet are often under recognized. This evidence-based practice
parameter
evaluates treatment options for the nonmotor
symptoms of PD. Articles pertaining to cognitive and mood dysfunction in
PD,
as well as treatment of sialorrhea with botulinum
toxin, were previously reviewed as part of American Academy of Neurology
practice parameters and were not included here.
Methods: A literature
search of MEDLINE, EMBASE, and Science Citation Index was performed to
identify clinical trials in patients
with nonmotor symptoms of PD published between 1966
and August 2008. Articles were classified according to a 4-tiered level
of evidence scheme and recommendations were based
on the level of evidence.
Results and Recommendations:
Sildenafil citrate (50 mg) may be considered to treat erectile
dysfunction in patients with Parkinson disease (PD) (Level
C). Macrogol (polyethylene glycol) may be
considered to treat constipation in patients with PD (Level C). The use
of levodopa/carbidopa
probably decreases the frequency of spontaneous
nighttime leg movements, and should be considered to treat periodic limb
movements
of sleep in patients with PD (Level B). There is
insufficient evidence to support or refute specific treatments for
urinary
incontinence, orthostatic hypotension, and anxiety
(Level U). Future research should include concerted and
interdisciplinary
efforts toward finding treatments for nonmotor
symptoms of PD.
