Treatments given in conjunction with each other to provide benefits that one treatment alone cannot deliver, to supplement the primary treatment, or to offset undesired effects of the primary treatment. Typically adjunct therapies enter into the treatment picture when Parkinson’s disease enters its middle and later stages as the effectiveness of Levodopa or dopamine agonist monotherapy wanes. dopamine agonist medications, bromocriptine, ropinerole, pramipexole, and pergolide, for example, act on dopamine receptors in the brain. Other medications usually used as adjunct therapies include anticholinergic medications, amantadine medications, monoamine oxidase inhibitor (maoi) medications, and COMT inhibitor medications, though all of these except coMT inhibitors may potentially be used as monotherapy in early disease.
Adjunct therapies often involve various and changing combinations of medications. Although this ongoing variation can be frustrating for physicians and patients alike, it is partly the consequence of the wide variability of the course of Parkinson’s disease and partly the consequence of reduced effectiveness of anti-parkinson medications and the development of motor fluctuations over time. Adjunct therapies also can include ablative surgery such as pallidotomy or thalamotomy and deep brain stimulation. Most doctors prefer to maintain monotherapy for as long as it adequately relieves symptoms before moving into adjunct therapies to reduce the risk of medication-induced side effects. The interval before adjunct therapies become part of the treatment package depends on multiple factors, however, and varies from individual to individual.
