Dopamine agonist therapy in Parkinson's disease: Spanish expert consensus on its use in different clinical situations
Abstract
Background: Different types of therapies were proven effective for the medical management of motor and non-motor symptoms in Parkinson’s disease (PD). We aimed to gain consensus on the dopamine agonist (DA) therapy use in different clinical scenarios of Parkinson’s disease (PD) patients. Methods: This consensus study was based on the nominal group technique. Initially, a consensus group comprising 12 expert neurologists in the PD field identified the topics to be addressed and elaborated different evidence-based preliminary statements. Next, a panel of 48 Spanish neurologists expressed their opinion on an internet-based systematic voting program. Finally, initial ideas were reviewed and rewritten according to panel contribution and were ranked by the consensus group using a Likert-type scale. The analysis of data was carried out by using a combination of both qualitative and quantitative methods. The consensus was achieved if the statement reached ≥ 3.5 points in the voting process. Results: The consensus group produced 76 real-world recommendations. The topics addressed included 12 statements related to DA therapy in early PD, 20 statements concerning DA treatment strategy in patients with motor complications, 11 statements associated with DA drugs and their side effects, and 33 statements regarding DA therapy in specific clinical scenarios. The consensus group did not reach a consensus on 15 statements. Conclusion: The findings from this consensus method represent an exploratory step to help clinicians and patients in the appropriate use of DA in different stages and clinical situations of PD.
Full text
Neu ología
40
(2025)
171—181
NEUROLOGÍA
www.else ie .es/neu ologia
ORIGINAL
ARTICLE
Dopamine
agonis
he apy
in
Pa kinson’s
disease:
Spanish
expe
consensus
on
i s
use
in
di e en
clinical
si ua ions
D.
San os
Ga cíaa,∗,
J.
Pagonaba aga
Mo ab,
F.
Escamilla
Se illac,d,
P.J.
Ga cía
Ruize,
J.
In an e
Cebe io ,g,
J.
Kulise sky
Boja skib,
G.
Linazaso o
C is óbalh,
M.R.
Luquín
Piudoi,
J.C.
Ma ínez
Cas illoj,
S.
Jesús
Maes ek,
L.
Vela
Desojol,
F.J.
Campos
Lucasm,
F.
Caballe o
Ma ínezm,
P.
Mi n,o,p,
Panel
o
Expe s
Phase
11
aSe icio
de
Neu ología,
CHUAC
(Complejo
Hospi ala io
Uni e si a io
de
A
Co u˜
na),
As
Xubias
84,
15006
A
Co u˜
na,
Spain
bHospi al
de
la
San a
C eu
i
San
Pau,
C/de
S .
An oni
Ma ia
Cla e ,
167,
08025
Ba celona,
Spain
cUnidad
de
T as o nos
del
Mo imien o,
Se icio
de
Neu ología,
Hospi al
Uni e si a io
Vi gen
de
las
Nie es,
A .
de
las
Fue zas
A madas,
2,
18014
G anada,
Spain
dIns i u o
de
In es igación
Biosani a ia
(ibs.G anada),
G anada,
Spain
eHospi al
Uni e si a io
Fundación
Jiménez
Díaz,
A .
de
los
Reyes
Ca ólicos,
2,
28040
Mad id,
Spain
Se icio
de
Neu ología,
Hospi al
Uni e si a io
de
Ma qués
de
Valdecilla-IDIVAL,
Calle
Ca denal
He e a
O ia,
39011
San ande ,
Can ab ia,
Spain
gCen o
de
In es igación
Biomédica
en
Red
en
En e medades
Neu odegene a i as
(CIBERNED),
Uni e sidad
de
Can ab ia,
San ande ,
Spain
hPoliclínica
Gipuzkoa,
Paseo
de
Mi amón,
174,
20014
San
Sebas ián,
Gipuzkoa,
Spain
iClínica
Uni e sidad
de
Na a a,
A .
de
Pío
XII,
36,
31008
Pamplona,
Na a a,
Spain
jHospi al
Uni e si a io
Ramón
y
Cajal,
IRYCIS,
Ca e e a
M-607,
9,
100,
28034
Mad id,
Spain
kUnidad
de
T as o nos
del
Mo imien o,
Se icio
de
Neu ología
y
Neu ofisiología
Clínica,
Hospi al
Uni e si a io
Vi gen
del
Rocío,
Ins i u o
de
Biomedicina
de
Se illa,
A .
Manuel
Siu o ,
S/n,
41013
Se illa,
Spain
lHospi al
Uni e si a io
Fundación
Alco cón,
C/
Budapes ,
1,
28922
Alco cón,
Mad id,
Spain
mFacul ad
de
Medicina,
Uni e sidad
F ancisco
de
Vi o ia,
Ca e e a
Pozuelo,
km
1800,
28223
Majadahonda,
Mad id,
Spain
nUnidad
de
T as o nos
del
Mo imien o,
Se icio
de
Neu ología
y
Neu ofisiología
Clínica,
Ins i u o
de
Biomedicina
de
Se illa,
(IBiS),
Hospi al
Uni e si a io
Vi gen
del
Rocío/CSIC/Uni e sidad
de
Se illa,
A .
Manuel
Siu o ,
S/n,
41013
Se illa,
Spain
oCen o
de
In es igación
Biomédica
en
Red
sob e
En e medades
Neu odegene a i as
(CIBERNED),
Calle
Valde ebollo,
5,
28031
Mad id,
Spain
pDepa amen o
de
Medicina,
Facul ad
de
Medicina,
Uni e sidad
de
Se illa,
A .
de
Sánchez
Pizjuán,
s/n,
41009
Se illa,
Spain
Recei ed
28
Ma ch
2023;
accep ed
1
Ap il
2023
A ailable
online
5
July
2023
KEYWORDS
Dopamine
agonis ;
Pa kinson’s
disease;
Expe
consensus
Abs ac
Backg ound:
Di e en
ypes
o
he apies
we e
p o en
e ec i e
o
he
medical
managemen
o
mo o
and
non-mo o
symp oms
in
Pa kinson’s
disease
(PD).
We
aimed
o
gain
consensus
on
he
dopamine
agonis
(DA)
he apy
use
in
di e en
clinical
scena ios
o
Pa kinson’s
disease
(PD)
pa ien s.
DOI
o
e e s
o
a icle:
h ps://doi.o g/10.1016/j.n l.2023.04.002.
∗Co esponding
au ho .
E-mail
add ess:
[email p o ec ed]
(D.
San os
Ga cía).
1Panel
o
Expe s
Phase
1
a e
lis ed
in
Appendix
A.
h ps://doi.o g/10.1016/j.n leng.2023.04.008
2173-5808/©
2023
Sociedad
Espa˜
nola
de
Neu olog´
ıa.
Published
by
Else ie
Espa˜
na,
S.L.U.
This
is
an
open
access
a icle
unde
he
CC
BY-NC-ND
license
(h p://c ea i ecommons.o g/licenses/by-nc-nd/4.0/).
D.
San os
Ga cía,
J.
Pagonaba aga
Mo a,
F.
Escamilla
Se illa
e
al.
Me hods:
This
consensus
s udy
was
based
on
he
nominal
g oup
echnique.
Ini ially,
a
consensus
g oup
comp ising
12
expe
neu ologis s
in
he
PD
field
iden ified
he
opics
o
be
add essed
and
elabo a ed
di e en
e idence-based
p elimina y
s a emen s.
Nex ,
a
panel
o
48
Spanish
neu ologis s
exp essed
hei
opinion
on
an
in e ne -based
sys ema ic
o ing
p og am.
Finally,
ini ial
ideas
we e
e iewed
and
ew i en
acco ding
o
panel
con ibu ion
and
we e
anked
by
he
consensus
g oup
using
a
Like - ype
scale.
The
analysis
o
da a
was
ca ied
ou
by
using
a
combina ion
o
bo h
quali a i e
and
quan i a i e
me hods.
The
consensus
was
achie ed
i
he
s a emen
eached
≥
3.5
poin s
in
he
o ing
p ocess.
Resul s:
The
consensus
g oup
p oduced
76
eal-wo ld
ecommenda ions.
The
opics
add essed
included
12
s a emen s
ela ed
o
DA
he apy
in
ea ly
PD,
20
s a emen s
conce ning
DA
ea -
men
s a egy
in
pa ien s
wi h
mo o
complica ions,
11
s a emen s
associa ed
wi h
DA
d ugs
and
hei
side
e ec s,
and
33
s a emen s
ega ding
DA
he apy
in
specific
clinical
scena ios.
The
consensus
g oup
did
no
each
a
consensus
on
15
s a emen s.
Conclusion:
The
findings
om
his
consensus
me hod
ep esen
an
explo a o y
s ep
o
help
clinicians
and
pa ien s
in
he
app op ia e
use
o
DA
in
di e en
s ages
and
clinical
si ua ions
o
PD.
©
2023
Sociedad
Espa˜
nola
de
Neu olog´
ıa.
Published
by
Else ie
Espa˜
na,
S.L.U.
This
is
an
open
access
a icle
unde
he
CC
BY-NC-ND
license
(h p://c ea i ecommons.o g/licenses/by-nc-nd/
4.0/).
PALABRAS
CLAVE
Agonis a
dopaminé gico;
En e medad
de
Pa kinson;
Consenso
de
expe os
T a amien o
con
agonis as
dopaminé gicos
en
la
en e medad
de
Pa kinson:
Consenso
de
expe os
espa˜
noles
sob e
su
uso
en
di e en es
si uaciones
clínicas
Resumen
An eceden es:
Se
demos ó
la
e ec i idad
de
di e en es
ipos
de
e apias
pa a
el
a amien o
médico
de
los
sín omas
mo o es
y
no
mo o es
en
la
en e medad
de
Pa kinson
(EP).
Nos
p o-
pusimos
log a
un
consenso
sob e
el
uso
de
la
e apia
con
agonis as
dopaminé gicos
(DA)
en
di e en es
escena ios
clínicos
de
pacien es
con
en e medad
de
Pa kinson
(EP).
Mé odos:
Es e
es udio
de
consenso
se
basó
en
la
écnica
de
g upo
nominal.
Inicialmen e,
un
G upo
de
Consenso
o mado
po
12
neu ólogos
expe os
en
el
campo
de
la
EP
iden ificó
los
emas
a
a a
y
elabo ó
di e en es
decla aciones
p elimina es
basadas
en
la
e idencia.
A
con-
inuación,
un
panel
de
48
neu ólogos
espa˜
noles
exp esó
su
opinión
en
un
p og ama
de
o ación
sis emá ica
a
a és
de
In e ne .
Finalmen e,
las
ideas
iniciales
ue on
e isadas
y
eesc i as
de
acue do
con
la
con ibución
del
panel
y
ue on
clasificadas
po
el
g upo
de
Consenso
u ilizando
una
escala
ipo
Like .
El
análisis
de
los
da os
se
lle ó
a
cabo
median e
una
combinación
de
mé odos
cuali a i os
y
cuan i a i os.
El
consenso
se
alcanzaba
si
la
afi mación
alcanzaba
≥3,5
pun os
en
el
p oceso
de
o ación.
Resul ados:
El
G upo
de
Consenso
elabo ó
76
ecomendaciones
pa a
el
mundo
eal.
Los
emas
abo dados
incluye on
12
afi maciones
elacionadas
con
la
e apia
con
DA
en
la
EP
emp ana,
20
afi maciones
ela i as
a
la
es a egia
de
a amien o
con
DA
en
pacien es
con
complicaciones
mo o as,
11
afi maciones
asociadas
con
los
á macos
DA
y
sus
e ec os
secunda ios,
y
33
afi ma-
ciones
ela i as
a
la
e apia
con
DA
en
escena ios
clínicos
específicos.
El
G upo
de
Consenso
no
llegó
a
un
consenso
en
15
afi maciones.
Conclusiones:
Los
esul ados
de
es e
mé odo
de
consenso
ep esen an
un
paso
explo a o-
io
pa a
ayuda
a
clínicos
y
pacien es
en
el
uso
ap opiado
de
la
DA
en
di e en es
es adios
y
si uaciones
clínicas
de
la
EP.
©
2023
Sociedad
Espa˜
nola
de
Neu olog´
ıa.
Publicado
po
Else ie
Espa˜
na,
S.L.U.
Es e
es
un
a ´
ıculo
Open
Access
bajo
la
licencia
CC
BY-NC-ND
(h p://c ea i ecommons.o g/licenses/by-
nc-nd/4.0/).
In oduc ion
Pa kinson’s
disease
(PD)
is
a
ch onic,
p og essi e
diso de
caused
by
he
g adual
loss
o
dopamine gic
neu ons
in
he
midb ain
dopamine gic
nucleus.1Di e en
he apies
we e
p o en
e ec i e
o
ea ing
mo o
symp oms
in
PD,
including
dopamine
agonis s
(DA)
agen s,
aman adine,
monoamine
oxidase
ype
B
(MAO
B)
inhibi o s,
ca echol-O-me hyl
ans e ase
(COMT)
inhibi o s,
and
le odopa.
E en
hough
he
ea men
a senal
o
PD
has
been
a ailable
o
decades,
he e
a e
s ill
di e ences
in
ea men
app oaches
o
pa ien s
acing
simila
clinical
scena ios
and
consen-
sus
a ou ing
one
pa icula
s a egy
is
lacking.2Al hough
he
le odopa
ea men
s ill
ep esen s
he
mos
e ec i e
symp-
oma ic
ea men
o
PD,
i s
ch onic
use
migh
be
associa ed
wi h
challenging
complica ions
such
as
dyskinesias,
mo o
fluc u-
a ions,
o
lack
o
e ficacy.
Because
o
his,
i
is
p e e able
o
172
Neu ología
40
(2025)
171—181
only
use
low
doses
o
le odopa
he apy
du ing
he
ini ial
s ages
o
PD.3
In e es ingly,
di e en
o mula ions
o
he
app o ed
d ugs
ha e
been
p og essi ely
a ailable,
which
p o ided
a
p olonged
hal -li e
in
some
cases,
o
he
possibili y
o
use
en e al
o
pa en e al
d ug
deli e y
in
o he s.4These
addi ional
pha macological
o mula ions
o
commonly
used
d ugs
in
PD
acili a ed
pa ien
adhe ence
and
ol-
e ance
in
mos
cases
bu
added
mo e
he e ogenei y
in
pa ien
ca e.
The
DA
d ugs
ha e
a
widesp ead
use
in
daily
p ac ice,
as
hey
can
be
p esc ibed
bo h
a
disease
onse
as
a
symp oma ic
ea men ,
o
in
pa ien s
acing
mo o
fluc ua ions
du ing
ad anced
s ages
o
he
disease.5A
p esen ,
only
he
non-e go
DA
d ugs
a e
being
used
in
PD,
which
included
p amipexole,
opini ole,
o igo ine,
and
apomo phine.6The e
is
a
cu en
a iabili y
ega ding
which
DA
is
p esc ibed
o
a
specific
pa ien ,
and
his
migh
be
ela ed
o
he
d ugs’
o mula ions,
po en ial
ad e se
e ec s,
o
miscellaneous.
This
s udy
aimed
o
each
an
expe
consensus
on
he
app op ia e
use
o
DA
in
di e en
clinical
scena ios
o
PD.
Me hods
S udy
design
A
nominal
g oup
echnique
p ocedu e
was
conduc ed
be ween
June
2020
and
May
2021.
The
consensus
ounds
we e
web-based
and
in-
pe son
due
o
epidemiological
conce ns
ela ed
o
he
COVID-19
pandemic.
The
wo kflow
o
he
p ocess
used
in
his
s udy
is
p e-
sen ed
in
Fig.
1.
Ini ially,
a
consensus
g oup
was
ec ui ed
by
using
a
snowball
sampling
echnique.
This
g oup
was
composed
o
12
neu ologis s,
expe s
in
he
PD
field,
who
iden ified
he
opics
o
be
add essed.
Topic
selec ion
The
documen
was
mean
o
add ess
consensus
on
using
DA
agen s
in
di e en
clinical
se ings
o
pa ien s
wi h
PD.
The
main
opics
o
be
add essed
we e
done
by
3
membe s
o
he
consensus
g oup
(PMR,
JPM,
DSG)
a e
hough ul
delibe a ion.
The
clinical
scena ios
con-
side ed
included:
1)
DA
he apy
in
ea ly
PD;
2)
DA
he apy
in
PD
pa ien s
wi h
mo o
complica ions;
3)
DA
he apy
in
pa ien s
expe-
iencing
i s
po en ial
side
e ec s
(impulse
con ol
diso de s
[ICD],
pa hological
gambling,
ea men
in ole ance);
and
4)
DA
he apy
in
pa ien s
acing
non-mo o
symp oms
o
PD
(neu opsychia ic
symp-
oms,
au onomic
dys unc ion,
sleep
diso de s).
Nex ,
a
sys ema ic
sea ch
on
PubMed,
EMBASE,
Índice
Médico
Espa˜
nol,
and
LILACS
was
pe o med.
This
ask
was
assigned
o
a
specialised
eam
o
documen alis s
om
he
In es iga ion
Uni ,
F ancisco
de
Vi o ia
School
o
Medicine,
Mad id,
who
adjus ed
and
d a ed
he
ele an
clinical
ques ions
using
he
PICO
model
(P-
p oblem,
I-in e en ion,
C-compa ison,
O-ou come).
Then,
he
consensus
g oup
unde wen
a
web-based
mee ing
on
May
24,
2021,
in
o de
o
sys ema ically
discuss
he
selec ed
pape s,
exchange
ideas,
and
s a
he
2- ound
nominal
g oup
echnique
o ing.7In
he
fi s
ound,
di e en
opics
we e
p esen ed
o
a
panel
o
48
neu ologis s
om
all
o e
Spain
o
explo e
hei
opinion
on
using
DA
in
a ious
clinical
scena ios.
The
fi s
su ey
used
an
open-ended
ound
in
o de
o
acili a e
he
panellis s’
eedback.
Because
o
his,
s a emen s
could
be
e iewed
o
modified
by
new
ideas,
acco ding
o
he
panellis s’
esponses,
o
acili a e
u u e
ag eemen .
In
he
second
ound,
he
consensus
g oup
combined
he
esul s
ob ained
om
ound
1
wi h
hei
sys ema ic
li e a u e
esea ch.
A e
his,
he
conclusions
we e
w i en
as
clinical
ec-
ommenda ions
and
s uc u ed
by
hema ic
blocks.
In
his
second
ound,
he
consensus
g oup
exp essed
hei
le el
o
ag eemen
o
disag eemen
on
he
di e en
s a emen s
using
a
Like - ype
scale.
Fo
doing
so,
he
panellis s
had
o
speci y
hei
le el
o
ag ee-
men
wi h
each
s a emen
using
a
5-poin
esponse
key,
anging
om
1
(s ongly
disag ee)
o
5
(s ongly
ag ee).
Finally,
a
consensus
documen
was
d a ed.
Panel
selec ion
The
expe
panel
consis ed
o
48
neu ologis s
om
di e en
Spanish
egions.
The
panellis s
we e
selec ed
as
ecognised
specialis s
in
he
clinical
and
academic
fields
o
PD.
A
o al
o
45
(93.7%)
o
hem
comple ed
all
he
o ing
ounds.
Consensus
g oup
me hod
The
nominal
g oup
echnique
is
a
aluable
me hod
used
o
achie e
consensus
among
pa icipan s
in
di e en
academic
fields,
and
i
is
con enien
o
explo ing
expe s’
ag eemen
in
heal hca e
esea ch.8In
his
echnique,
a
acili a o
asks
he
pa icipan s
o
con ibu e
wi h
a ying
poin s
o
iew
abou
a
specific
opic
in
a
s uc u ed
manne
in
o de
o
gene a e
a
lis
o
s a emen s.
Then,
he
g oup
discusses
and
complemen s
he
s a emen s
wi h
new
ideas
as
necessa y.
Each
pa icipan
usually
anks
he
asse ion
by
o ing
on
an
o dinal
scale.
Finally,
he
esul s
a e
analysed
and
e iewed
in
o de
o
de e mine
he
o e all
g oup
ag eemen s.9
S a is ical
Analysis
The
analysis
o
da a
was
ca ied
ou
by
using
a
combina ion
o
bo h
quali a i e
and
quan i a i e
me hods.
Expe s’
opinions
and
quo es
eco ded
du ing
he
mee ings
and
he
online
p ocess
we e
used
o
help
unde s and
indi idual
and
g oup
a ionale.
In
some
cases,
he
pe sonal
commen s
om
he
panellis s
we e
used
o
c oss-checking
agains
w i en
in o ma ion
o
imp o e
he
consensus
g oup’s
ideas.
The
quan i a i e
analysis
was
ob ained
and
s a is ically
analysed
a e
he
consensus
g oup
sco ed
and
anked
he
di e en
s a e-
men s.
Resul s
a e
shown
by
using
he
mean
and
s anda d
de ia ion
(SD).
In
ou
s udy,
consensus
was
conside ed
o
ha e
been
eaced
o
s a emen s
sco ing
≥
3.5
poin s
on
he
consensus
g oup
o ing.10
Resul s
As
a
esul ,
he
ad iso y
commi ee
p oduced
76
eal-wo ld
ecom-
menda ions
on
he
p oposed
main
opics
(Tables
1-4).
The
consensus
g oup
eached
ag eemen
on
11
s a emen s
ela ed
o
DA
he apy
in
ea ly
PD,
14
s a emen s
conce ning
DA
ea men
s a egy
in
pa ien s
wi h
mo o
complica ions,
6
s a emen s
associa ed
wi h
DA
d ugs
and
hei
side
e ec s,
and
27
s a emen s
ega ding
DA
he apy
in
specific
clinical
scena ios.
The
consensus
g oup
did
no
each
a
consensus
on
15
s a emen s.
Gene al
ecommenda ions
1)
Dopamine
agonis
he apy
in
ea ly
Pa kinson’s
disease
The
bes
ime
o
ini ia e
symp oma ic
ea men
a ies
significan ly
be ween
pa ien s,
acco ding
wi h
di e en
ac o s.
The
bes
ea -
men
o
adminis e
ini ially
in
PD
pa ien s
is
based
on
he
pa ien ’s
cha ac e is ics,
impac
o
disease
on
daily
ac i i ies,
and
he
pha -
macodynamics
o
he
selec ed
d ug.
The e
is
no
gene al
consensus
o
ad ise
clinicians
wi h
he
selec ion
o
he
ini ial
pha macological
ea men
o
PD.
The
mos
impo an
ac o s
ha
migh
influence
he
ea men
selec ion
a e
he
pa ien ’s
age,
se e i y
o
symp-
oms,
e olu ion
in
yea s,
he
an ipa kinsonian
powe
o
he
selec ed
d ug,
and
he
d ug- ela ed
side-e ec s.
Based
on
his,
clinicians
and
pa ien s
mus
discuss
he
bes
specific
pha macologic
op ion
ole ance.5,11 Table
1
shows
he
sxpe s’
ag eemen
on
DA
use
as
ini ial
he apy
in
PD.
173
D.
San os
Ga cía,
J.
Pagonaba aga
Mo a,
F.
Escamilla
Se illa
e
al.
Figu e
1
Design
and
wo kflow
o
he
s udy.
PD:
Pa kinson’s
disease.
Table
1
Dopamine
agonis
he apy
in
ea ly
Pa kinson’s
Disease.
Mean
(SD)
1
Non-e go
DA
(p amipexole,
opini ole,
and
o igo ine)
a e
e ec i e
in
ea ly
PD
as
mono he apy
(le el
o
e idence
A).
4.91
(0.29)
2
The
ea ly
use
o
DA
educes
he
incidence
o
de eloping
mo o
fluc ua ions
compa ed
o
le odopa.
On
he
con a y,
DA
has
less
he apeu ic
e ficacy
and
mo e
significan
side
e ec s.
4.27
(0.86)
3
The
compa ed
e ficacy
s udies
be ween
di e en
DA
agonis s
showed
no
s a is ical
di e ences.
4.18
(0.57)
4
The
e ficacy
o
ex ended- elease
o mula ions
o
p amipexole
and
opini ole
is
no
in e io
o
immedia e- elease
able s
du ing
he
ea ly
s ages
o
PD.
4.64
(0.48)
5
In
elde ly
pa ien s
(o e
70
yea s
o
age)
wi hou
demen ia,
ea men
wi h
DA
can
be
ini ia ed
i
he
pa ien
has
mild
o
mode a e
symp oms.
3.82
/1.03)
6
In
elde ly
pa ien s
(o e
70
yea s
o
age),
enal
unc ion
should
be
moni o ed
i
p amipexole
is
ini ia ed.
4.55
(0.50)
7
Ex ended- elease
o mula ions
o
p amipexole
and
opini ole
a o
ea men
compliance
due
o
hei
easy
posology
compa ed
o
immedia e- elease
able s.
4.64
(0.48)
8
The e
is
no
e idence
suppo ing
he
idea
ha
p amipexole
is
mo e
e ficien
in
educing
emo
in
PD
pa ien s
compa ed
o
o he
DA
agonis s.
4.09
(0.79)
9
Ro igo ine
imp o es
sleep
quali y,
pain
pe cep ion,
and
mo ning
akinesia.
4.45
(0.50)
10
P amipexole
has
a
mild
an idep essan
ac ion.
3.91
(0.29)
11
DA
ea men s,
including
p amipexole,
opini ole,
and
o igo ine,
a e
associa ed
wi h
impulse
con ol
diso de .
I
is
necessa y
o
discuss
his
po en ial
side
e ec
wi h
pa ien s,
especially
younge
ones.
5.00
(0)
12
Fu he
clinical
s udies
a e
needed
o
a ge
he
bes
ini ial
ea men
s a egy
o
ea ly
PD.
4.36
(0.64)
DA:
dopamine
agonis ;
PD:
Pa kinson’s
disease.
2)
Dopamine
agonis
he apy
in
Pa kinson’s
disease
pa ien s
wi h
mo o
complica ions
The
bes
ea men
s a egy
in
PD
pa ien s
acing
mo o
complica ions
mus
be
balanced
be ween
adequa e
con ol
o
he
symp oms
p oduced
by
he
selec ed
d ug
and
he
appea -
ance
o
ad e se
pha macological
e ec s.
Typically,
le odopa
is
he
mo e
e ec i e
ea men
o
educing
he
mo o
symp oms
o
PD,
al hough
i
is
mo e
equen ly
associa ed
wi h
de elopmen
o
dyskinesia
compa ed
o
DA,
especially
in
he
long- e m
ea men .
Despi e
he
lowe
isk
o
inducing
mo o
complica ions,
DA
d ugs
174
Neu ología
40
(2025)
171—181
Table
2
Dopamine
agonis
he apy
in
ad anced
Pa kinson’s
disease:
ea men
s a egy
in
pa ien s
wi h
mo o
complica ions.
Mean
(SD)
13
When
selec ing
a
DA,
he
ollowing
i ems
should
be
conside ed
in
pa ien s
wi h
mo o
fluc ua ions:
he
pa ien ’s
clinical
p ofile,
age
(especially
when
pa ien s
a e
<
60
yea s
old),
and
he
po en ial
addi ional
e ec
o
he
DA
ea men
on
o he
symp oms
o
PD.
4.18
(0.57)
14
In
pa ien s
wi h
dyskinesias,
dose
i a ion
is
sugges ed
o
imp o e
ea men
ole ance.
4.18
(0.94)
15
The e
a e
no
ele an
di e ences
be ween
indi idual
DA
d ugs
in
con olling
mo o
complica ions
o
PD,
as
hey
a e
dose-dependen .
4.18
(0.57)
16
P e e ably,
he
use
o
e go -de i ed
DA
d ugs
should
be
a oided.
4.91
(0.29)
17
Swi ching
om
one
DA
d ug
o
ano he
is
acili a ed
by
using
dose
equi alence
cha s.
4.09
(0.79)
18
DA
ex ended- elease
o al
o mula ions
and
anscu aneous
o mula ions
a e
p e e ed
o e
immedia e- elease
able s
due
o
hei
easie
dosage
and
i a ion
(especially
wi h
o igo ine).
4.45
(.050)
19
Ex ended- elease
DA
o mula ions
a e
mo e
e ec i e
in
con olling
fluc ua ions
compa ed
o
immedia e- elease
able s.
2.64
(0.88)
20
When
pa ien s
ha e
mo o
complica ions,
DA
d ugs
imp o e
o he
non-mo o
symp oms,
especially
apa hy,
dep ession,
and
es less
legs
synd ome.
4.09
(0.51)
21
When
pa ien s
ha e
mo o
complica ions,
DA
d ugs
can
imp o e
o he
non-mo o
symp oms
such
as
pain,
insomnia,
and
a igue.
4.00
(0.60)
22
When
pa ien s
ha e
mo o
complica ions,
p amipexole
could
p o ide
a
be e
imp o emen
o
emo
compa ed
o
o he
AD
d ugs.
2.64
(0.64)
23
Apomo phine
has
a
lowe
po en ial
isk
o
neu opsychia ic
complica ions
han
o he
DA
d ugs
due
o
i s
pa icula
a fini y
o
dopamine gic
ecep o s.
3.55
(0.89)
24
When
using
in e mi en
injec ions
o
subcu aneous
apomo phine,
pa ien s
usually
equi e
ewe
han
5
injec ions
pe
day.
4.18
(0.57)
25
The
in e mi en
injec ions
o
subcu aneous
apomo phine
ha e
limi ed
long- e m
adhe ence.
3.64
(0.48)
26
I
is
ecommended
o
s a
ea men
wi h
CSAI
in
a
specialised
clinical
se ing
o
a
day
ca e
cen e.
4.64
(0.48)
27
CSAI
migh
ep esen
a
sui able
adjunc i e
he apy
in
specific
PD
pa ien s.
4.27
(0.62)
28
Fo
p esc ibing
CSAI,
he
ole
and
influence
o
he
ca egi e
a e
essen ial.
4.27
(0.62)
29
CSAI
is
gene ally
well
ole a ed.
3.36
(0.88)
30
Pa ien s’
como bidi ies
should
be
assessed
be o e
ini ia ing
a
DA
d ug
(ie,
enal
ailu e,
o al
an icoagula ion
wi h
couma ins).
4.73
(0.45)
31
DA
d ugs
a e
usually
ini ia ed
be o e
he
pa ien
de elops
mo o
complica ions.
The e o e,
DAs
a e
no
con enien
when
pa ien s
ha e
mo o
fluc ua ions
(excep
when
dose
adjus men
is
equi ed).
2.00
(1.28)
32
DA
he apy
imp o es
he
quali y
o
li e
in
pa ien s
acing
mo o
complica ions.
4.00
(0.43)
CSAI:
con inuous
subcu aneous
apomo phine
in usion;
DA:
dopamine
agonis ;
PD:
Pa kinson’s
disease.
a e
associa ed
wi h
an
inc eased
isk
o
de eloping
specific
ad e se
e en s,
including
somnolence,
hallucina ions,
and
beha io
diso -
de s.
Fu he mo e,
DA
a e
no
well
ole a ed
in
elde ly
pa ien s,
especially
hose
wi h
p e ious
cogni i e
impai men .
The
ad an-
ages
and
disad an ages
o
he
di e en
he apeu ic
s a egies
in
pa ien s
wi h
mo o
complica ions
mus
be
weighed
ca e ully
by
bo h
clinicians
and
pa ien s,
p io i ising
he
pa ien ’s
specific
needs
and
con ex .
Table
2
shows
he
expe s’
ag eemen
on
DA
use
in
PD
pa ien s
wi h
mo o
complica ions.
3-Dopamine
agonis
he apy
in
pa ien s
expe iencing
i s
po en ial
ad e se
e ec s
(impulse
con ol
diso de s,
ea men
in ole ance)
Some
side
e ec s
caused
by
DA
agen s
and
le odopa
migh
be
sim-
ila
and
may
ange
om
mild
o
se e e
in ensi y.
They
include
nausea,
omi ing,
sleepiness,
o hos a ic
hypo ension,
con usion,
and
hallucina ions.
Ne e heless,
pa ien s
on
DA
he apies
a e
mo e
likely
o
de elop
pe iphe al
oedema,
somnolence,
cons ipa ion,
dizziness,
hallucina ions,
and
nausea
compa ed,
and
DA- ea ed
pa ien s
a e
mo e
likely
o
discon inue
ea men
due
o
ad e se
e en s.6Se e i y
o
ICD
can
ange
om
mild
symp oms
associa ed
wi h
compulsi e
beha io
(soli ai e-playing,
compulsi e
cleaning,
e c)
o
mo e
se e e
and
des uc i e
conduc ,
such
as
pa hologi-
cal
gambling
o
hype sexuali y.
The
ICD
can
be
de eloped
a
any
s age
o
PD
and
in
pa ien s
on
any
dopamine gic
he apy,
bu
i
is
mo e
equen ly
obse ed
in
PD
pa ien s
aking
DA
d ugs.5ICD
migh
imp o e
wi h
DA
discon inua ion,
bu
some
pa ien s
migh
main ain
compulsi e
symp oms
a e
DA
cessa ion.12 Table
3
shows
he
expe s’
ag eemen
on
DA
he apy
use
in
PD
pa ien s
acing
i s
po en ial
side
e ec s.
175
D.
San os
Ga cía,
J.
Pagonaba aga
Mo a,
F.
Escamilla
Se illa
e
al.
Table
3
Dopamine
agonis s
and
side
e ec s.
Mean
(SD)
33
No
all
DA
d ugs
ha e
he
same
isk
o
sys emic
side
e ec s.
3.55
(0.78)
34
The
equency
o
sys emic
side
e ec s
is
simila
when
using
an
ex ended- elease
DA
o mula ion
compa ed
o
immedia e- elease
able s.
3.64
(0.54)
35
Gas oin es inal
side
e ec s
a e
common
wi h
DA
ea men .
3.45
(0.66)
36
Gas oin es inal
side
e ec s
a e
mo e
p e alen
in
pa ien s
on
DA
mono he apy
compa ed
wi h
hose
on
adjunc i e
le odopa
he apy.
3.00
(0.60)
37
Acco ding
o
he
exis ing
e idence,
opini ole
would
be
ela ed
o
highe
nausea
and
dizziness
a es
compa ed
o
o he
DA
d ugs.
3.00
(0.74)
38
Lowe
limb
oedema
in
pa ien s
on
DA
ea men
is
ela ed
o
specific
p edisposing
isk
ac o s
such
as
pa ien
gende
and
DA
ea men
du a ion.
3.18
(1.11)
39
Lowe
limb
oedema
is
no
clea ly
ela ed
o
any
pa icula
ype
o
DA
d ug.
3.82
(0.94)
40
A
swi ch
o
DA
d ug
could
be
conside ed
i
lowe
limb
oedema
appea s
as
a
side
e ec .
3.64
(0.64)
41
Dompe idone
could
be
used
o
nausea
p e en ion.
4.64
(0.48)
42
Dompe idone
can
inc ease
he
elec oca diog am
QTc
in e al,
so
i
should
be
used
wi h
cau ion
and
empo a ily.
4.45
(0.5)
43
O hos a ic
hypo ension
is
no
clea ly
ela ed
o
DA
use.
2.64
(1.49)
DA:
dopamine
agonis ;
PD:
Pa kinson’s
disease.
176
Neu ología
40
(2025)
171—181
Table
4
Dopamine
agonis s
in
specific
clinical
scena ios.
Mean
(SD)
A)
ICD
44
The
diagnosis
o
ICD
could
be
unde es ima ed
in
cases
o
unawa eness
om
ela i es.
4.91
(0.29)
45
The
diagnosis
o
ICD
may
di e
depending
on
he
clinime ic
p ope ies
o
he
di e en
a ailable
diagnosis
scales.
4.91
(0.29)
46
The
p esence
o
dep ession
ac s
as
a
p emo bid
isk
ac o
o
su e ing
an
ICD
wi h
he
use
o
DA.
4.45
(0.78)
47
In
pa ien s
wi h
p emo bid
isk
ac o s
o
an
ICD,
he
use
o
DA
d ugs
should
be
a oided.
4.27
(0.75)
48
The
dose
o
DA
ea men
is
associa ed
wi h
he
isk
o
an
ICD.
4.45
(0.5)
49
Le odopa
ea men
and
dose
influence
he
genesis
o
ICD.
3.82
(0.83)
50
No
all
DA
d ugs
ha e
he
same
isk
o
being
associa ed
wi h
an
ICD.
3.73
(0.86)
51
AD
ea men s
p esen
a
di e en
isk
o
inducing
an
ICD
depending
on
hei
elease
o mula.
3.00
(0.95)
52
Ro igo ine
ea men
could
be
associa ed
wi h
less
isk
o
de eloping
an
ICD.
3.82
(0.57)
53
Apomo phine
has
a
lowe
isk
o
being
associa ed
wi h
an
ICD
compa ed
o
o al
o
ansde mal
DA
d ugs.
4.00
(0.60)
54
The
dose
o
he
DA
should
be
educed
in
he
p esence
o
a
mild
ICD.
3.73
(0.75)
55
A
swi ch
o
DA
could
be
conside ed
i
he
ICD
is
mild
o
mode a e.
2.82
(0.94)
56
The
dose
o
he
DA
should
be
educed
in
he
e en
o
a
mode a e-se e e
ICD.
4.00
(1.18)
57
The
DA
ea men
should
be
wi hd awn
i
pa ien s
de elop
a
mild
ICD.
2.91
(0.79)
58
The
DA
should
be
wi hd awn
in
he
e en
o
a
mode a e-se e e
ICD.
4.55
(0.66)
59
In
cases
o
mode a e-se e e
ICD,
he
dose
o
le odopa
should
also
be
educed.
2.45
(0.5)
60
Scien ific
e idence
is
lacking
o
ecommend
he
use
o
o he
addi ional
d ugs
o
he
ea men
o
ICD.
4.27
(0.62)
61
In
pa ien s
wi h
a
his o y
o
ICD
using
DA
ea men ,
he
use
o
hese
d ugs
should
be
es ic ed
in
he
u u e.
4.45
(0.66)
62
In
pa ien s
wi h
a
his o y
o
ICD
wi h
o al
o
ansde mal
DA,
who
a e
candida es
o
second-line
he apies,
he
use
o
con inuous
in usion
wi h
subcu aneous
apomo phine
should
be
a oided.
3.09
(0.79)
63
Dopamine gic
dys egula ion
synd ome
is
mainly
associa ed
wi h
he
use
o
le odopa.
4.18
(0.83)
B)
DAWS
64
The e
a e
p emo bid
ac o s
ha
p edic
he
appea ance
o
a
DAWS.
4.09
(0.51)
65
In
pa ien s
in
whom
DA
has
been
wi hd awn
due
o
side
e ec s,
such
as
an
ICD,
i s
ein oduc ion
could
be
conside ed
i
hey
ha e
su e ed
a
DAWS.
3.82
(0.57)
C)
Sleep
Diso de s
66
DA
d ugs
a e
e ec i e
in
imp o ing
sleep
diso de s
in
PD
pa ien s
(noc u nal
akinesia,
agmen ed
sleep,
RLS)
4.45
(0.50)
67
Al hough
o igo ine
has
mo e
a o able
scien ific
e idence,
o he
DA
he apies
may
be
equally
e ec i e
in
imp o ing
sleep
diso de s
in
pa ien s
wi h
PD.
4.00
(0.60)
68
DA
d ugs
ha e
shown
o
be
no
e ec i e
in
ea ing
REM
sleep
beha iou
diso de
in
pa ien s
wi h
PD.
4.09
(0.67)
69
In
case
o
d owsiness
associa ed
wi h
a
DA
ea men ,
i
may
be
help ul
o
swi ch
he
DA
d ug,
p e e ably
o
o igo ine.
3.45
(0.66)
D)
Cogni ion
and
beha iou
70
In
a
pa ien
wi h
PD
and
cogni i e
impai men ,
i
is
ecommended
o
a oid
he
use
o
DA
ea men s.
3.82
(0.72)
71
I
is
unnecessa y
o
a
pa ien
on
DA
ea men
who
de elops
cogni i e
impai men
wi hou
psycho ic
symp oms
o
educe
DA
dose
unless
neu opsychia ic
complica ions
appea .
3.73
(0.86)
72
In
pa ien s
wi h
PD
olde
han
80
yea s,
wi hou
cogni i e
impai men ,
i
is
p e e able
o
a oid
he
use
o
DA.
4.00
(0.74)
E)
Miscellanous
73
The
combina ion
o
2
DA
is
no
ecommended,
excep
o
he
addi i e
use
o
apomo phine
in
pen
o
in usion.
4.55
(0.66)
177
D.
San os
Ga cía,
J.
Pagonaba aga
Mo a,
F.
Escamilla
Se illa
e
al.
Table
4
(Con inued)
Mean
(SD)
74
In
pa ien s
using
a
diu nal
apomo phine
in usion
pump,
he
concomi an
use
o
a
noc u nal
DA
ex ended- elease
ea men
may
be
help ul.
4.36
(0.48)
75
In
pa ien s
wi h
PD
on
DA
he apies
who
unde go
deep
b ain
s imula ion
he apy,
i
is
ecommended
no
o
educe
he
DA
dose
by
mo e
han
70%
in
he
ea ly
pos -su gical
s ages
in
o de
o
a oid
apa hy
as
a
side
e ec .
4.18
(0.39)
76
In
pa ien s
wi h
PD
who
a e
on
Duodopa,
DA
d ugs
may
help
ea
non-mo o
mani es a ions,
such
as
sleep
diso de s.
4.45
(0.50)
DA:
dopamine
agonis ;
DAWS:
dopamine
agonis
wi hd awal
synd ome:
ICD:
impulse
con ol
diso de s;
PD:
Pa kinson’s
disease;
REM:
apid
eye
mo emen ;
RLS:
es less
legs
synd ome.
4-Dopamine
agonis
he apy
in
PD
pa ien s
wi h
non-mo o
symp oms
PD
pa ien s
may
expe ience
di e en
ypes
o
non-mo o
symp oms,
which
can
be
ela ed
o
he
disease
p ope
o
he
pha macologic
d ugs
adminis e ed.
The
non-mo o
symp oms
include
a
di e en
ange
o
neu opsychia ic
symp oms
ha
goes
om
anxie y,
apa-
hy,
and
mood
diso de
o
cogni i e
dys unc ion,
hallucina ions,
and
o he
psycho ic
symp oms.13 Also,
PD
pa ien s
migh
ha e
sleep
diso de s,
including
insomnia,
pa asomnias,
and
es less
legs
synd ome.
Au onomic
symp oms
can
also
be
p esen ,
including
o hos a ic
hypo ension,
sexual
dys unc ion,
and
cons ipa ion.13 On
he
o he
hand,
pa ien s
on
DA
ea men
migh
de elop
a
wi h-
d awal
synd ome,
especially
i
he
d ug
is
apidly
emo ed.14 The
DA
ea men
wi hd awal
usually
includes
psychological,
au onomic,
and
mo o
mani es a ions
such
as
anxie y,
panic
a acks,
dep es-
sion,
swea ing,
omi ing,
weakness,
ins abili y,
and
DA
d ug
c a ing.
These
symp oms
a e
ypically
e ac o y
o
o he
an ipa kinsonian
ea men s,
including
le odopa,
and
migh
only
be
con olled
by
eplacing
he
specific
DA
wi hd awn
d ug.15 Table
4
shows
he
expe s’
ag eemen
on
DA
use
in
pa ien s
wi h
non-mo o
symp oms
o
PD.
Discussion
The
cu en
ange
o
ea men
op ions
a ailable
o
idiopa hic
PD
is
b oad,
whe e
ea men
s a egy
can
be
di ided
in o
pha macolog-
ical,
non-pha macological,
and
su gical
he apy.
Ou
s udy
used
a
nominal
g oup
echnique
o
help
each
an
expe
consensus
ega d-
ing
he
ad an ages
and
disad an ages
o
DA
use
in
di e en
clinical
si ua ions.
Tailo ing
a
ea men
s a egy
o
indi idual
pa ien s
equi es
ca e ul
conside a ion
o
di e en
ac o s,
ha
include
he
pa ien ’s
symp oms,
age,
disease
s age,
unc ional
disabili y,
and
li es yle.
Unlike
le odopa,
he
pha macological
e ec s
o
he
DA
d ugs
a e
exe ed
by
hei
di ec
in e ac ion
wi h
he
dopamine
ecep o s
and
he e o e
mimicking
he
endogenous
dopamine.
In e es ingly,
DA
ea men s
can
be
used
bo h
a
he
ea ly
s ages
o
he
disease
and
in
mo e
ad anced
s ages
when
pa ien s
exhibi
mo o
and
non-
mo o
complica ions.
Fu he mo e,
DA
d ugs
ha e
all
been
shown
o
alue
as
mono he apy,
ypically
in
pa ien s
wi h
ea ly
disease
cou se
(s a emen
1).
As
a
esul ,
i
is
commonly
ecommended
in
daily
p ac ice
o
use
a
minimum
dose
o
le odopa
o
o
delay
i s
ini ia ion
un il
pa ien s
ha e
symp oms
ha
in e e e
wi h
daily
unc ion-
ing
o
impai
hei
quali y
o
li e
(s a emen
2).
The e
is
limi ed
in o ma ion
ega ding
head- o-head
compa isons
o
he
e ficacy
o
di e en
DAs,
showing
no
significan
di e ence
be ween
each
o he
o
only
sligh
supe io i y
o
one
d ug
o e
ano he
(s a emen
3).
As
a
consequence,
he
DA
d ug
selec ed
o
ea
a
pa icula
pa ien
is
usually
based
on
conce ns
ela ed
o
i s
o mula ion,
dos-
ing
equency,
and
cos .16,17 This
can
explain
he
b oad
clinical
si ua ions
whe e
DA
he apies
a e
being
p esc ibed,
based
mainly
on
he
pa ien s’
and
doc o s’
p e e ences.
When
planning
a
ailo ed
ea men
s a egy,
clinicians
should
conside
cogni i e
s a us
and
enal
unc ion
in
elde ly
pa ien s
(s a emen s
5-6),
and
d ug
o mu-
la ions
(s a emen
7)
in
o de
o
imp o e
ole ance
and
adhe ence.
Also,
di e en
como bidi ies
o
he
pa ien s
can
help
he
DA
elec-
ion
a
disease
onse
(s a emen s
9-10).
Finally,
all
he
non-e go
DA
d ugs
can
be
associa ed
wi h
ICD,
and
i
is
ecommended
o
discuss
his
po en ial
side
e ec
when
p esc ibing
hese
d ugs
(s a emen
11).
The
de elopmen
o
mo o
fluc ua ions
o e
ime
is
a iable
and
mos ly
depends
on
he
p og essi e
degene a ion
o
nig os ia al
dopamine
e minal,
a he
han
he
ini ial
ea men
s a egy.18
Fu he mo e,
he e
is
inc easing
e idence
ha
he
choice
and
im-
ing
o
ini ial
he apy
o
PD,
whe he
le odopa,
DA
o
MAO
B
inhibi o
migh
ha e
a
minimum
impac
on
he
long- e m
p e a-
lence
o
mo o
fluc ua ions
and
dyskinesia.19 Ne e heless,
a
subs an ial
p opo ion
o
pa ien s
wi h
PD
migh
de elop
le odopa-
ela ed
mo o
complica ions
yea s
a e
s a ing
le odopa.20 These
complica ions
include
mo o
fluc ua ions
and
di e en
ypes
o
complex
oscilla ions
in
mo o
unc ion.
In
pa ien s
expe iencing
dyskinesias,
adding
a
non-e go
DA
migh
help
o
educe
challeng-
ing
symp oms.5,21 In
hose
cases,
such
d ugs
as
opi inole,
o igo ine
o
p amipexole
can
be
all
equally
conside ed,
p e e ably
using
an
ex ended- elease
o mula ions
(s a emen s
15-17).
Fu he ,
when
used
as
an
add-on,
DA
should
be
s a ed
wi h
a
lowes
dose
and
i a ed
cau iously
and
s a ing
wi h
he
lowes
dose
possible
(s a e-
men s
14,
18).
Addi ionally,
DA
d ugs
can
help
o
imp o e
non-mo o
symp oms
o
PD
(s a emen s
20-21).
In
pa ien s
acing
ad anced
s ages
o
PD,
apomo phine
can
also
ha e
a
key
ole
in
hei
clinical
managemen .
Apomo phine
is
a
non-
e goline
DA
wi h
a
high
a fini y
o
dopamine
D
1-2
ecep o s.22 I
has
a
simila
e ficacy
o
le odopa
in
con olling
mo o
symp oms
o
PD,
and
i
is
p esc ibed
o
he
con ol
o
mo o
fluc ua ions.
I
is
used
subcu aneously
bo h
as
an
in e mi en
injec ion
o
as
con inuous
in usion
(s a emen s
24-27).
Al hough
apomo phine
has
a
apid
and
sho
onse
o
ac ion,
a
lowe
isk
o
neu opsychia ic
complica ions
(s a emen
23),
and
a
good
ole abili y
when
i
is
used
as
a
con inuous
in usion,
pa ien s
and
ca egi e
educa ion
migh
be
essen ial
o
i s
co ec
use
(s a emen
28).
E en
hough
DA
he apy
has
an
impo an
ole
in
pa ien s
wi h
ad anced
PD
as
a
ea men
o
le odopa-induced
mo o
complica ions,
i s
use
migh
be
associa ed
wi h
spe-
cific
complica ions
(s a emen s
33-34).
The
spec um
o
side
e ec s
associa ed
wi h
DA
migh
be
wide,
and
can
ange
om
gas oin es inal
discom o
and
lowe
limb
oedema
o
significan
neu opsychia ic
complica ions
(s a emen s
39-41).
Fo
ins ance,
DA
d ugs
a e
mos
commonly
associa ed
wi h
he
de elopmen
o
ICDs
such
as
pa hological
gambling,
compulsi e
sexual
beha iou ,
o
compulsi e
shopping
in
up
o
50%
o
pa ien s
wi h
long- e m
use.23
Risk
ac o s
o
i s
de elopmen
include
male
sex,
younge
age,
a
178
Neu ología
40
(2025)
171—181
highe
dose
o
DA,
and
p e ious
his o y
o
ICD
(s a emen s
44-48).
Fu he mo e,
dep ession
could
ac
as
a
p emo bid
isk
ac o
o
su e ing
an
ICD
wi h
he
use
o
DA
(s a emen
46).24 Rega ding
he
DA
ype,
o igo ine
and
apomo phine
could
be
associa ed
wi h
less
isk
o
de eloping
an
ICD
(s a emen s
50,
52-53).
When
an
ICD
is
p esen ,
i
is
ecommended
o
ape
he
DA
g adually
in
o de
o
imp o e
he
symp oma ology
(s a emen s
54,
56,
58,
60).25 Highe
doses
o
le odopa
may
be
associa ed
wi h
a
small
inc ease
in
isk
o
ICD
(s a emen
49).26
Mo eo e ,
al hough
le odopa
is
conside ed
he
mos
po en
ig-
ge
o
dopamine
dys egula ion
synd ome
in
PD
(s a emen
63),
subcu aneous
apomo phine
and
o al
DA
may
also
be
esponsible.27
I
usually
in ol es
male
pa ien s
wi h
ea ly-onse
PD
who
ake
inc easing
quan i ies
o
dopamine gic
d ugs,
despi e
ha ing
se e e
d ug- ela ed
dyskinesia.28 Finally,
DA
should
be
a oided
in
elde ly
adul s
due
o
inc eased
isk
cogni i e
impai men
o
in
pa ien s
wi h
a
his o y
o
ICD,
demen ia,
hype somnia,
o
hallucina ions
(s a emen s
70-72).
The
limi a ions
o
his
s udy
a e
ela ed
o
he
ac
ha
i
is
based
on
expe
opinion
and
au ho s
we e
challenged
o
each
consensus
on
opics
who
migh
ha e
a
limi ed
esea ch
backg ound.
To
add ess
ha
issue,
he
consensus
g oup
used
he
la ge
backup
panel
o
neu ologis s
o
gain
consis ency
and
homogenei y.
Also,
i
should
be
no ed
ha
au ho s
and
pa icipan s
based
hei
opinion
on
local
egula ions,
and
changes
in
sa e y
ecommenda ions
may
no
apply
in
di e en
coun ies.
Finally,
ega ding
he
opics
ha
no
eached
expe
consensus,
au ho s
belie es
ha
i
is
ela ed
he
clinical
he e ogenei y
ha
clinicians
mus
usually
ace
in
hei
daily
p ac ice,
and
consequen ly
hose
opics
should
be
add essed
in
a
pe sonalised
app oach.
Conclusion
DA
ep esen s
an
e ec i e
op ion
o
ea
PD
and
allow
he
use
o
lowe
doses
o
le odopa
he apy,
pos poning
hei
po en ial
side
e ec s.
In
addi ion,
DA
migh
also
p o ide
benefi s
in
mo e
ad anced
disease
s ages
by
educing
mo o
fluc ua ions
associa ed
wi h
he
long- e m
le odopa
he apy.
Ou
wo k
p o ides
insigh s
in o
whe e
DA
e en ually
fi
in o
he
ea men
schemes
o
PD
in
daily
p ac ice.
The
conclusions
de i ed
om
i
ep esen
an
explo a o y
s ep
om
which
he
ou comes
should
be
used
o
guide
u he
quali a i e
and
quan i a i e
esea ch
designs.29 In
any
case,
DA
as
a
g oup,
has
been
conside ed
he
mos
po en
ancilla y
an ipa kinsonian
medica ion
a ailable.5
Conflic
o
in e es
San os
Ga cía
D.
has
ecei ed
hono a ia
o
educa ional
p esen a-
ions
and
ad ice
se ice
by
Abb ie,
UCB
Pha ma,
Lundbeck,
KRKA,
Zambon,
Bial,
I al a maco,
Te a,
A chímedes,
Es e e,
S ada,
Me z,
and
g an s
om
he
Spanish
Minis y
o
Economy
and
Compe i i e-
ness
[PI16/01575]
co- ounded
by
ISCIII
(Concesión
de
sub enciones
de
P oyec os
de
In es igación
en
Salud
de
la
con oca o ia
2020
de
la
Acción
Es a égica
en
Salud
2017-2020
po
el
p oyec o
‘‘PROGRESIÓN
NO
MOTORA
E
IMPACTO
EN
LA
CALIDAD
DE
VIDA
EN
LA
ENFERMEDAD
DE
PARKINSON’’).
Pagonaba aga
Mo a
J.
has
ecei ed
hono a ia
o
educa ional
p esen a ions
and
ad ice
se ice
by
Abb ie,
UCB
Pha ma,
Lundbeck,
Zambon,
Bial,
and
Es e e.
Escamilla
Se illa
F.
has
ecei ed
hono a ia
o
educa ional
p e-
sen a ions
and/o
ad ice
se ice
by
Abb ie,
Bial,
Bos on
Scien ific,
Es e e,
Med onic,
S ada,
UCB
Pha ma
and
Zambon.
Ga cía
Ruiz
P.J.
has
ecei ed
pe sonal
compensa ion
as
a
consul-
an /scien ific
ad iso y
boa d
om
I al a maco,
B i annia,
Bial,
S ada
and
Zambon
and
speaking
hono a ia
om
I al a maco,
Bial,
Zambon,
Me z,
Dyspo
and
Abb ie.
In an e
Cebe io
J.
has
ecei ed
hono a ia
o
educa ional
p e-
sen a ions
and
ad ice
se ice
om
Abb ie,
Zambon
and
Bial.
Jaime
Kulise sky
Boja ski
J.
has
no
conflic s
o
in e es .
Linazaso o
C is óbal
G.
CEO,
ounde
and
sha eholde
o
VIVE
bio ech
SL.
He
has
ecei ed
hono a ia
o
educa ional
p esen-
a ions,
ad iso y
se ice
and
pa icipa ion
in
esea ch
p ojec s
and
clinical
ials
by
No a is,
UCB,
Lundbeck,
Bial,
Abb ie,
As a
Médica,
Te a,
K ka,
Med onic,
Boeh inge ,
Sche ing,
Pha macia,
Lilly,
Dupon ,
I al á maco,
Alle gan,
Ipsen,
Me z,
Zambón,
Biogen,
Roche,
Genen ech
and
O yzon.
Luquín
Piudo
M.R.
has
ecei ed
hono a ia
o
educa ional
p e-
sen a ions
and
ad ice
se ices
by
Abb ie,
UCB
Pha ma,
Zambon,
Bial,
Es e e,
and
g an s
om
he
Spanish
Heal h
Ins i u e
Ca los
III
and
Eu opean
Commission.
Ma ínez
Cas illo
J.C.
has
ecei ed
g an s/ esea ch
suppo
om
Alle gan,
AbbVie,
Bial,
Ipsen,
I al a maco,
Me z,
and
Zambon
;
hono a ia
o
consul a ion
ees
om
Alle gan,
AbbVie,
Bial,
Exel is,
Ipsen,
I al a maco,
Me z,
Ipsen,
O ion,
TEVA,
UCB,
and
Zambon
;
and
company
sponso ed
speake ’s
bu eau
om
Alle gan,
AbbVie,
Bial,
K ka,
Ipsen,
I al a maco,
Me z,
TEVA,
UCB,
and
Zambon.
Jesús
S.
has
ecei ed
hono a ia
om
Abb ie,
Zambon,
Bial,
I al a maco,
Me z.
She
holds
he
g an
‘‘Acción
B
Clínicos-
In es igado es
(B-0007-2019)’’
om
he
‘‘Conseje ía
de
Salud
y
Familias’’
and
she
ecei ed
he
g an
PI21/01901
ounded
by
he
‘‘Ins i u o
de
Salud
Ca los
III’’.
Vela
Desojo
L.
has
no
conflic s
o
in e es .
Campos
Lucas
F.J.
has
no
conflic s
o
in e es .
Caballe o
Ma ínez
F.
has
no
conflic s
o
in e es .
Pablo
Mi
P.
has
ecei ed
suppo
o
a ending
mee ings
and/o
a el
o
hono a ium
o
lec u ing
om
Abbo ,
Alle gan,
Abb ie,
Bial,
B i annia,
I al a maco,
Me z,
UCB,
Te a,
S ada
and
Zambon.
Funding
This
s udy
was
unded
by
he
Chai
o
Epilepsy
and
Mo emen
Dis-
o de s
UFV-UCB.
Acknowledgemen s
We
hank
he
neu ologis s
who
pa icipa ed
in
phase
1
o
hei
disin e es ed
collabo a ion.
We
hank
he
Epilepsy
and
Mo emen
Diso de s
UFV-UCB
Chai
o
suppo ing
his
ini ia i e.
We
hank
I ene
San ama ía
o
he
F ancisco
de
Vi o ia
Uni e si y
o
he
echnical
coo dina ion
wo k
o
his
s udy.
Appendix
A
Panel
o
Expe s
A aceli
Alonso
Cáno as1;
José
Ma ías
A belo
González2;
Bego˜
na
A es
Pensado3;
Asunción
Á ila
Ri e a4;
Nu ia
Caballol
Pons5;
MaTe esa
Cáce es
Redondo6;
Víc o
Manuel
Cam-
pos
A illo7;
Ma
Ca mona
Abellán8;
Fá ima
Ca illo
Ga cía9;
MaJosé
Ca alán
Alonso10;
Es he
Cubo
Delgado11;
Bea -
iz
De
la
Casa
Fages12;
Edua do
de
Pablo-Fe nández13;
Se illa14;
Madel
Ca men
Fe nández
Mo eno15;
Juan
Ga -
cía
Calden ey16;
Rocío
Ga cia-Ramos17;
Juan
Ca los
Gómez
Es eban18;
Jéssica
González
A du a19;
Ja ie
Gu ié ez
Ga cía20;
An onio
Koukoulis
Fe nández21;
Monica
Ku is
U a22;
Inés
Lega da
Ramí ez23;
Luis
Ja ie
López
del
179