Guidelines for Parkinson’s disease treatment: consensus from the Movement Disorders Scientific Department of the Brazilian Academy of Neurology - motor symptoms

Saba, Roberta Arb; Maia, Débora Palma; Cardoso, Francisco Eduardo Costa; Borges, Vanderci; F. Andrade, Luiz Augusto; Ferraz, Henrique Ballalai; Barbosa, Egberto Reis; Rieder, Carlos Roberto de Mello; da Silva, Delson José; Chien, Hsin Fen; Capato, Tamine; Rosso, Ana Lúcia; Souza Lima, Carlos Frederico; Bezerra, José Marcelo Ferreia; Nicaretta, Denise; Povoas Barsottini, Orlando Graziani; Godeiro-Júnior, Clécio; Broseghini Barcelos, Lorena; Cury, Rubens Gisbert; Spitz, Mariana; Azevedo Silva, Sônia Maria César; Della Colletta, Marcus Vinicius

doi:10.1590/0004-282X-ANP-2021-0219

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Sumário

Brazilian Academy of Neurology • Arq. Neuro-Psiquiatr. 80 (3) • Mar 2022 • https://doi.org/10.1590/0004-282X-ANP-2021-0219 copy

Guidelines for Parkinson’s disease treatment: consensus from the Movement Disorders Scientific Department of the Brazilian Academy of Neurology - motor symptoms

Diretrizes para o tratamento da doença de Parkinson: consenso do Departamento Científico de Transtornos do Movimento da Academia Brasileira de Neurologia - sintomas motores

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

The treatment of Parkinson's disease (PD) is challenging, especially since it is considered highly individualized. The Brazilian Academy of Neurology has recognized the need to disseminate knowledge about the management of PD treatment, adapting the best evidence to the Brazilian reality. Thus, the main published treatment guidelines were reviewed based on the recommendations of group from the Movement Disorders Scientific Department of the Brazilian Academy of Neurology.

Keywords:
Parkinson Disease; Antiparkinson Agents; Deep Brain Stimulation; Rehabilitation

	Monotherapy	Adjuvant Therapy
Levodopa	Level A	Level A
Dopaminergic Agonist
Bromocriptine	Level C - Ineffective
Pramipexole	Level A
Rotigotine	Level A
MAO-B Inhibitors
Selegiline	Level B	Level B
Rasagiline	Level A	Level B
Safinamide		Level C
Amantadine	Level C	Level C
Anticholinergics	Level B	Level B

	Fluctuations
Levodopa controlled release	No evidence
Dopaminergic Agonist
Pramipexole	Level A
Rotigotine	Level A
MAO-B Inhibitors
Selegiline	Level A
Rasagiline	Level A
Safinamide	Level A
COMT Inhibitors	Level A
Amantadine	Ineffective
STN-DBS	Level A

	Dyskinesias
Amantadine	Level B
Clozapine	Level U
STN-DBS	Level A

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[1] Correspondence:
Roberta Arb Saba Rodrigues Pinto; Email: roarbsaba@gmail.com.

Class I	A randomized, controlled clinical trial of the intervention of interest with masked or objective outcome assessment, in a representative population. The a to e criteria* is also required.
Class II	A randomized controlled clinical trial of the intervention of interest in a representative population with masked or objective outcome assessment that lacks one criterion a-e above or a prospective matched cohort study with masked or objective outcome assessment in a representative population that meets b-e above.
Class III	All other controlled trials (including well-defined natural history controls or patients serving as own controls) in a representative population, where outcome is independently assessed, or independently derived by objective outcome measurement
Class IV	Studies not meeting Class I, II, or III criteria including consensus or expert opinion.

A	Established as effective, ineffective, or harmful (or established as useful/predictive or not useful/predictive) for the given condition in the specified population
B	Probably effective, ineffective, or harmful (or probably useful/predictive or not useful/predictive) for the given condition in the specified population
C	Possibly effective, ineffective, or harmful (or possibly useful/predictive or not useful/predictive) for the given condition in the specified population
U	Data inadequate or conflicting; given current knowledge, treatment (test, predictor) is unproven

Levodopa + carbidopa	Tablet, 250mg + 25 mg
Levodopa + benserazide	Tablet, 200 mg + 50 mg
Levodopa + benserazide BD (low dose)	Tablet, 100 mg + 25 mg
Levodopa + benserazide (oral dispersible)	Tablet, 100 mg + 25 mg
Levodopa + benserazide HBS (Hydrodynamically Balanced System)	Capsule, 100 mg + 25 mg
Levodopa + benserazide DR (Dual Release)	Tablet, 200mg + 50 mg