Treatment of early Parkinson's disease

Abstract

Parkinson's disease, a progressive neurodegenerative disorder, affects about 1% of the population over the age of 50. While it has no cure, it is the only neurodegenerative disorder with a range of medical and neurosurgical treatments that substantially reduce clinical symptoms.1 However, medical management of early Parkinson's disease is controversial because of the potential risks and benefits to patients. Some clinicians prefer to use levodopa, a dopamine precursor, since it promptly relieves symptoms. Others prescribe dopamine agonists and withhold levodopa because of its long term complications, namely abnormal involuntary movements and potential neurotoxicity. Inevitably, managing the side effects of antiparkinsonian drugs becomes a therapeutic focus along with treating the primary motor abnormalities.1 Extended controlled clinical trials are the only means of obtaining evidence based guidance on the use of dopamine agonists or levodopa for the management of early Parkinson's disease. The results of a recent multisite, five year, randomised, double blind study comparing the incidence of dyskinesia with levodopa or ropinirole, a dopamine D2 receptor agonist,2 should sway practitioners towards initial treatment with agonists for early Parkinson's disease. In contrast to the hypokinesis that characterises Parkinson's disease, dyskinesias related to antiparkinsonian drugs involve hyperkinetic choreoathetoid, lurching, and jerky movements. These movements are thought …