The MDS 2026 Congress in Seoul presents advances in managing movement disorders including Parkinson's disease, essential tremor, dystonia, and Huntington's disease. This overview captures key management strategies presented at the conference.
Pharmacologic Approaches:
- Levodopa/carbidopa — Gold standard; consider continuous infusion for advanced disease
- Dopamine agonists — Pramipexole, ropinirole, rotigotine; better for younger patients
- MAO-B inhibitors — Selegiline, rasagiline, safinamide; first-line or adjunct therapy
- COMT inhibitors — Entacapone, opicapone, tolcapone; extend levodopa effect
Treatment Algorithm:
- Initial diagnosis → MAO-B inhibitor or dopamine agonist
- Moderate symptoms → add levodopa
- Motor fluctuations → optimize dosing, add COMT inhibitor
- Dyskinesias → reduce levodopa, add amantadine
Deep Brain Stimulation (DBS):
- Targets: Subthalamic nucleus (STN) or globus pallidus internus (GPi)
- Benefits: Reduced motor fluctuations, dyskinesias, medication needs
- Advances at MDS 2026: Directional leads, closed-loop systems, MRI-guided targeting
Continuous Drug Delivery:
- Duodopa/Duopa — Intestinal gel infusion
- Apomorphine infusion — Continuous subcutaneous delivery
- First-line: Propranolol, primidone
- Second-line: Gabapentin, topiramate, benzodiazepines
- Refractory: Consider surgical intervention
- Thalamic DBS (VIM) — Excellent tremor control
- Focused ultrasound (FUS) — Non-invasive thalamotomy
- Laser interstitial thermal therapy (LITT)
- OnabotulinumtoxinA (Botox)
- AbobotulinumtoxinA (Dysport)
- IncobotulinumtoxinA (Xeomin)
- Anticholinergics — Trihexyphenidyl, benztropine
- Baclofen — GABA-B agonist
- Benzodiazepines — Clonazepam, diazepam
- Dopamine-depleting agents — Tetrabenazine
- GPi DBS — For refractory generalized or segmental dystonia
- Ventral oralis thalamotomy
- Tetrabenazine, deutetrabenazine — VMAT2 inhibitors for chorea
- Antipsychotics — Haloperidol, olanzapine
- Gene-silencing therapies — Targeting HTT gene mutations
- Neuroprotective strategies — Creative supplementation, exercise
- RBD: Clonazepam, melatonin
- Insomnia: Sleep hygiene, cognitive behavioral therapy
- Depression: SSRIs (citalopram, sertraline)
- Psychosis: Pimavanserin, quetiapine
- Anxiety: Benzodiazepines, SSRIs
- Orthostatic hypotension: Fludrocortisone, midodrine
- Constipation: Fiber, laxatives, prokinetics
MDS 2026 highlights digital tools:
- Wearable sensors — Accelerometers for objective measurement
- Smartphone apps — Remote monitoring, symptom tracking
- Telehealth — Remote consultations, virtual assessments
- Machine learning — Predictive models for progression