Motor symptoms are those that affect movement of the body. These are the cardinal symptoms of PD. The main motor symptoms of PD are tremor, slowness of movement (bradykinesia), stiffness (rigidity), and poor balance (postural instability). These symptoms are usually mild in the early stages of the disease. PD patients show additional motor deficits, including: gait disturbance, impaired handwriting, grip force and speech deficits, among others.

The goal of medical management of Parkinson disease is to provide control of signs and symptoms for as long as possible while minimizing adverse effects.

First-line treatment

Advice Levodopa to people in the early stages of Parkinson's disease whose motor symptoms impact on their quality of life. Levodopa is most effective at relieving bradykinesia and rigidity and often substantially reduces tremor.

Levodopa/carbidopa mainstay of treatment in most patients. Coadministration of the carbidopa prevents levodopa from being decarboxylated into dopamine outside the brain (peripherally), thus lowering the levodopa dosage required to produce therapeutic levels in the brain and minimizing adverse effects due to dopamine in the peripheral circulation.

Consider a choice of levodopa, dopamine agonists, or monoamine oxidase B (MAO‑B) inhibitors for people in the early stages of Parkinson's disease whose motor symptoms do not impact on their quality of life.

Levodopa/carbidopa/entacapone: This can be particularly useful for patients whose Parkinson’s disease symptoms reappear before their next medication dose is due. Entacapone always used with levodopa, particularly when response to levodopa is wearing off.

MAO-B inhibitor (Rasagiline, Selegiline): can be considered first-line treatment for milder symptoms for initial treatment of early disease.

Dopamine agonist (Pramipexole, Ropinirole, Rotigotine): Monotherapy in early disease and adjunctive therapy in moderate to advanced disease use with caution in elderly and those at risk of impulse control disorders (gambling, alcohol use disorder, hypersexual behaviour).

Other treatment

Anticholinergic (Benztropine, Trihexyphenidyl): Second-line drugs for tremor only. Useful occasionally for prominent rest tremor. Use with caution in elderly and those with cognitive frailty.

NMDA receptor antagonist (Amantadine): Useful for management of dyskinesia. Use with caution in patients with cardiac failure.