Title : Advancing Parkinson’s disease management: From dopaminergic therapy to deep brain stimulation and beyond
Abstract:
Parkinson’s Disease (PD) is a progressive Parkinson's disease characterized by degeneration of dopaminergic neurons in the substantia nigra, resulting in motor dysfunction, cognitive decline, and substantial long-term socioeconomic burden. Despite advances in symptomatic treatment, durable disease management remains limited by medication-related complications, delayed diagnosis, inequitable access to advanced therapies, and the absence of widely implemented disease-modifying interventions. This narrative review synthesizes current and emerging approaches to PD management through a translational framework integrating pharmacologic therapy, neuromodulation, biomarker development, and healthcare systems analysis.
Levodopa, administered in combination with carbidopa, remains the cornerstone of treatment but is constrained by a progressively narrowing therapeutic window, motor fluctuations, dyskinesias, and polypharmacy-related complications. Deep Brain Stimulation provides significant symptomatic improvement in appropriately selected patients, though long-term outcomes depend on multidisciplinary evaluation, postoperative optimization, and economic accessibility. Beyond symptom management, PD imposes substantial direct and indirect costs through caregiver burden, reduced productivity, psychiatric comorbidity, and long-term care needs.
Emerging diagnostic strategies, including blood- and cerebrospinal fluid–based biomarkers, advanced molecular imaging, and artificial intelligence–assisted neuroimaging, show promise for earlier detection and individualized intervention. By integrating biological mechanisms, clinical therapeutics, surgical innovation, diagnostic technologies, and systems-level economic considerations, this review highlights the need for a comprehensive, multimodal, and patient-centered approach to improve long-term outcomes and support sustainable PD care.
Keywords: PD; Dopamine replacement therapy; Levodopa; Deep brain stimulation; Neurodegeneration; Biomarkers; Precision medicine
