AAN Updates Its Recommendations for Treating Motor Symptoms in Early Parkinson Disease

The American Academy of Neurology has updated its recommendations on initiating treatment for motor symptoms in individuals with early Parkinson disease.1

The guidelines come as an update to the group’s 2002 recommendations on the use of dopaminergic medications when initiating treatment for Parkinson disease. The guidelines outline 3 treatment options that may improve motor symptoms: levodopa, dopamine agonists, and monoamine oxidase B (MAO-B) inhibitors.

While initial treatment with levodopa may provide more-significant improvements in motor symptoms when compared with the other 2 treatments, levodopa may increase the risk of dyskinesia within the first 5 years of treatment. The guideline panel found that the prevalence of severe or disabling dyskinesia was low during the first 5 years of treatment. Health care practitioners are encouraged to prescribe the lowest dose of levodopa that will still be effective.

Dopamine agonists may be more likely to cause hallucinations, impulse-control disorders, and excessive daytime sleepiness. Individuals taking dopamine agonists or MAO-B inhibitors may be more likely to stop treatment because of adverse effects than individuals taking levodopa. Individuals taking MAO-B inhibitors are more likely to need additional therapy within 2 to 3 years of initiating this treatment.

“We carefully reviewed the available research on the effectiveness and possible risks of medications to treat motor symptoms in people with early Parkinson’s disease and found that levodopa is usually the best first treatment for these symptoms,” said guideline coauthor Tamara Pringsheim, MD, MSc, in a press release.2 “Still, there are side effects with levodopa as well as other drugs, so it is important that a person newly diagnosed with Parkinson’s disease discusses all options with their neurologist before deciding on the best treatment plan for them.”


—Leigh Precopio


  1. Pringsheim T, Day GS, Smith DB, et al; Guideline Subcommittee of the AAN. Dopaminergic therapy for motor symptoms in early Parkinson disease practice guideline summary: a report of the AAN Guideline Subcommittee. Neurology. 2021;97(20):942-957. doi:10.1212/WNL.0000000000012868
  2. AAN issues guideline for treatment of early Parkinson’s disease. News release. American Academy of Neurology; November 15, 2021. Accessed November 16, 2021.

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