Thirty Years of Parkinson's Disease Management: From a Symptom-Based Approach to a Holistic Perspective

No neurological disorder other than Parkinson's disease (PD) can boast so many revolutionary events, in its history. The treatment of choice has primarily been the dopamine precursor levodopa. After its introduction, the impact of disease on mortality significantly decreased, yet affected people had to face severe drug-related side effects. Around 40 years ago, other symptomatic drugs, including monoamine oxidase type B (MAO-B) inhibitors and dopamine agonists (DA), used as first-line therapy in de novo patients, were reportedly effective at preventing the levo-Dopa long-term treatment syndrome. Afterwards, catechol-O-methyltransferase inhibitors and long-release DA were added to the toolkit, as a means to obtain a steady control on motor symptoms, but their effectiveness was overtaken, 30 years ago, by functional neurosurgery that ensured brilliant results with the bilateral subthalamic deep brain stimulation (DBS) technique. Notwithstanding such care improvement, people with PD still experienced long-lasting ever-growing disability. Over the last 10 years, evidence on the efficacy of motor training has accumulated, supporting the role of exercise for promoting activity-dependent neuroplasticity, thus opening a new perspective on non-pharmacological disease modifying interventions.