Introduction: The progression of Parkinson's disease and levodopa therapy leads to development of motor and psychic complications that cause serious limitations to the management of the advanced disease.
Development: This article reviews the current literature regarding the pathophysiology and the therapeutic approaches to the management of motor and psychic fluctuations in Parkinson's disease.
Conclusions: 1. The most important risk factors for the development of motor fluctuations are the young age at onset and severity of Parkinson's disease, and duration and maximum dose of levodopa. 2. Pathophysiological data include the denervation of substantia nigra compacta and postsynaptic pharmacodynamic mechanisms, with a lesser contribution of pharmacokinetic factors. 3. The main therapeutic approaches include changes in the form of administration of levodopa, inhibitors of levodopa catabolism, and dopamine agonists. 4. A number of psychiatric symptoms, including depression, panic attacks, mania and cognitive impairment, can have a fluctuating course, coinciding with the motor fluctuations.