Dopaminergic Therapies for Parkinson's Disease in Under-Resourced Settings

Parkinson's disease (PD) is a progressive neurodegenerative disorder characterized by diminished striatal dopamine levels resulting from the degeneration of dopaminergic neurons in the substantia nigra. About 10 million people around the world are affected by this disease. Levodopa was first used in the 1960s as a symptomatic cure for the disease and it is still the mainstay or PD treatment. Levodopa is not always available in low- and middle-income countries (LMICs) because of problems with the supply chain, high costs, and a lack of diagnostics. In rural areas without pharmacovigilance, doctors use cheaper alternatives like Mucuna pruriens or Vicia faba beans. The Parkinson's Disease and Movement Disorder Society in India is an example of a community-based model that stresses multidisciplinary care to fill in the gaps by teaching carers about levodopa timing, voice therapy, and physiotherapy. Wearables for monitoring, telemedicine, changes to registries, and generic medication policies all help promote equity.