ABSTRACT
PRINCIPLES OF THERAPY OF PARKINSON’S DISEASE Keep the Patient Functioning Independently as Long as Possible A number of drugs have a favorable impact on the clinical features of Parkinson’s disease (PD), by reducing its symptoms, but, to date, none have been proven to stop the progression of the disease. Since PD is a progressive disease, and since no medication prevents ultimate worsening, the long-term goal in treating PD is to keep the patient functioning independently for as long as possible. Clearly, if medications that provide symptomatic relief can continue to be effective without producing adverse effects, this would be excellent. For example, if levodopa therapy could persistently reverse parkinsonian signs and symptoms, no additional therapy would be needed. The difficulty is that 75% of patients have serious complications after six years of levodopa therapy (1), and younger patients (less than 60 years of age) are particularly prone to develop the motor complications of fluctuations and dyskinesias (2,3). When beginning therapy, some physicians therefore recommend using dopamine agonists rather than levodopa in younger patients, in an attempt to delay the onset of these problems (4,5). Controlled, clinical trials comparing dopamine agonists and levodopa as the initial therapeutic agent have proven that motor complications are less likely to occur with dopamine agonists (6,7,8). But each of these studies also showed that levodopa was more effective in improving parkinsonian symptoms and signs, as measured quantitatively by the Unified Parkinson’s Disease Rating Scale (UPDRS).
