Table 4.

Summary of the recommendations of the MDS-EBM Committee (Fox et al. [2]) and the EAN Committee (Deuschl et al. [145]) on oral, device-aided treatments and lesional approaches for patients with troublesome motor fluctuations

MDS/EAN summary recommendations
	Levodopa/peripheral decarboxylase inhibitor	DAAs	COMT-I	MAO-B Is	Others
First-line, oral
Efficacious, clinically useful and no specialized monitoring for safety concerns	Standard formulation Extended release	Non-ergot DAAs (pramipexole IR/ER, ropinirole IR/PR, rotigotine, apomorphine sc)	Entacapone, Opicapone	Rasagiline, Safinamide, Zonisamide
Second-line, oral
Efficacious, clinically useful but with specialized monitoring		Ergot DAA (Pergolide)	Tolcapone
Efficacious, possibly useful and with specialized monitoring		Ergot DAAs (Bromocriptine and Cabergoline)
Likely efficacious, possibly useful and no specialized monitoring for safety concerns					Istradefylline
Insufficient evidence, investigational use	Controlled-formulation, rapid onset	Non-ergot DAA (Piribedil)		Selegiline and oral disintegrating selegiline	Amantadine IR (not analyzed for Amantadine ER)
Device-aided therapies or lesional therapies
	Pumps	Deep brain stimulation	Lesional
Efficacious, clinically useful but with specialized monitoring	Intestinal levodopa/cabidopa gel infusion	Bilateral STN-DBS Bilateral Gpi-DBS
Likely efficacious, possibly useful, with specialized monitoring for safety concerns	Apomorphine SC infusion
Efficacious, clinically useful but with specialized monitoring; to be considered only if DBS or pumps are not possible			Unilateral pallidotomy
Insufficient evidence, no data			MRg-focused ultrasound
Not recommended			Radiosurgery (VIM, Gpi, STN), radiofrequency lesioning of STN and thalamotomy