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Parkinson's Disease — RACP Adult Medicine MCQ

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ModerateNeurologyParkinson's DiseaseRACP Adult Medicine

A 60-year-old man with Parkinson's disease has been on levodopa/carbidopa for 5 years. He now experiences predictable wearing-off of motor benefit before his next dose is due. Which of the following strategies is most appropriate?

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Correct answer: B — Add entacapone (COMT inhibitor)

Wearing-off is the most common motor complication of levodopa therapy. Adding a COMT inhibitor (entacapone) extends the half-life of levodopa by blocking its peripheral metabolism, thereby smoothing motor fluctuations. Increasing levodopa frequency or adding an MAO-B inhibitor are alternatives. Apomorphine is reserved for refractory motor fluctuations.

Reference: eTG – 2025 – Neurology; MDS – 2023 – PD Treatment Guidelines