Treatment strategies in advanced Parkinson's disease: Review of the literature
Parkinson’s disease (PD) is a chronic, neurodegenerative disorder affecting basal ganglia, dopamine-secreting cells in the pars compacta region of the substantia nigra, in particular. It commonly affects people above the age of 50, however a younger –onset has also been reported. Since there is an ongoing dopaminergic cell death in basal ganglia, it is a progressive disorder leading to severe disability in the late stages of the disease. The advanced stages of PD are the most challenging part of the disease for clinicians, as well as the patients’ themselves due to the motor fluctuations, freezing of gait, dyskinesia, postural instability, falls, autonomic involvement, non-motor symptoms. This symptomatology corresponds to the stage of 4-5 on the Hoehn and Yahr (H&Y) scale, which is commonly defined as advanced PD. The treatment options in the patients with advanced PD are discussed in this review.
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