The therapy of the motor symptoms in the advanced stage of Parkinson's disease.

This review focuses on the medical treatment strategies for the advanced stages of Parkinson disease (PD), according to the therapeutic guideline for PD by the committee of Japanese Society of Neurology in 2011. Levodopa still remains the gold standard for the treatment of motor symptoms of PD in advanced stage, but dopamine agonists, monoamine oxidase B inhibitors and catechol-O-methyltransferase inhibitors have--also been developed to provide more continuous oral delivery of dopaminergic stimulation in order to prevent and improve levodopa-induced motor complications, including wearing off phenomenon and peak-dose dyskinesia. A number of non-dopaminergic receptors are expressed on different parts of the basal ganglia motor circuits and have become targets of PD drug development. Zonisamide, which has multimodal effects on the dopaminergic and non-dopaminergic systems, and istradefylline, the first adenosine A2A antagonist, have shown positive evidence for improved motor fluctuations.