EFNS TASK FORCE ARTICLE Review of the therapeutic management of Parkinson’s disease. Report of a joint task force of the European Federation of Neurological Societies and the Movement Disorder Society–European Section. Part I: early (uncomplicated) Parkinson’s disease M. Horstink a , E. Tolosa b , U. Bonuccelli c , G. Deuschl d , A. Friedman e , P. Kanovsky f , J. P. Larsen g , A. Lees h , W. Oertel i , W. Poewe j , O. Rascol k and C. Sampaio l a Department of Neurology, Radboud University Medical Centre, Nijmegen, The Netherlands; b Neurology Service, Hospital Clı´nic, Universitat de Barcelona, Barcelona, Spain; c Department of Neurosciences, University of Pisa, Pisa, Italy; d Department of Neurology, Christian-Albrechts-University Kiel, Germany; e Department of Neurology, Medical University of Warsaw, Warsaw, Poland; f Department of Neurology, Palacky University, Olomouc, Czech Republic; g Department of Neurology, Stavanger University Hospital, Stavanger, Norway; h Reta Lila Weston Institute of Neurological Studies, London, UK; i Centre of Nervous Diseases, Philipps-University of Marburg, Marburg, Germany; j Department of Neurology, Innsbruck Medical University, Innsbruck, Austria; k Clinical Investigation Centre, Departments of Clinical Pharmacology and Neurosciences, University Hospital, Toulouse, France; and l Laborato ´rio de Farmacologia Clinica e Terapeutica e Instituto de Medicina Molecular, Faculdade de Medicina de Lisboa, Lisbon, Portugal Keywords: management guideline, Parkinson’s disease, pharmacotherapy, physio- therapy, review. Received 8 March 2006 Accepted 13 March 2006 The aim of the study was to provide evidence-based recommendations for the man- agement of early (uncomplicated) Parkinson’s disease (PD), based on a review of the literature. Uncomplicated PD refers to patients suffering from the classical motor syndrome of PD only, without treatment-induced motor complications and without neuropsychiatric or autonomic problems. MEDLINE, Cochrane Library and Inter- national Network of Agencies for Health Technology Assessment (INAHTA) data- base literature searches were conducted. National guidelines were requested from all European Federation of Neurological Societies (EFNS) societies. Non-European guidelines were searched for using MEDLINE. Part I of the guidelines deals with prevention of disease progression, symptomatic treatment of motor features (par- kinsonism), and prevention of motor and neuropsychiatric complications of therapy. For each topic, a list of therapeutic interventions is provided, including classification of evidence. Following this, recommendations for management are given, alongside ratings of efficacy. Classifications of evidence and ratings of efficacy are made according to EFNS guidance. In cases where there is insufficient scientific evidence, a consensus statement (good practice point) is made. Background In the initial stages of disease, levodopa therapy is the most effective for improving motor symptoms in Par- kinson’s disease (PD). However, long-term treatment is accompanied by fluctuations in motor performance, dyskinesias, and neuropsychiatric complications. Fur- thermore, as PD progresses, patients develop features that do not respond well to levodopa therapy, such as freezing episodes, autonomic dysfunction, falling, and dementia, and symptoms related to the administration of other drugs. The increasingly diverse possibilities in the therapy of PD, and the many side effects and complications of therapy, require the formulation of reliable standards for patient care that are based on current scientific knowledge. This document provides these scientifically supported treatment recommendations. If the available evidence is less than level C, or if scientific evidence is lacking, best practice (good practice point) is recommended, based on the experience of the guideline development group. Methods The authors were invited by European Federation of Neurological Societies (EFNS) and Movement Disor- der Society–European Section (MDS–ES) to prepare an evidence-based review. Search strategy Searches were carried out in MEDLINE, the full data- base of the Cochrane Library, and the International Correspondence: Dr M. W. I. M. Horstink, Department of Neuro- logy, Radboud University Medical Centre, Nijmegen, the Netherlands (tel.: +31-24-3615202; fax: +31-24-3541122; e-mail: m.horstink@ neuro.umcn.nl). 1170 Ó 2006 EFNS European Journal of Neurology 2006, 13: 1170–1185 doi:10.1111/j.1468-1331.2006.01547.x