| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
Approved by the Quality Standards Subcommittee on August 11, 2001. Approved by the Practice Committee on October 17, 2001. Approved by the AAN Board of Directors on October 20, 2001.
Address correspondence and reprint requests to the American Academy of Neurology, 1080 Montreal Avenue, St. Paul, MN 55116.
In 1993, the last AAN Practice Parameter on medical treatment of Parkinson’s disease (PD) concluded that levodopa was the most effective drug for management of this disorder. Since then, a number of new compounds including non-ergot dopamine agonists (DA) and sustained-release levodopa have been released and studied. Thus, the issue of treatment in de novo PD patients warrants reexamination. Specific questions include: 1) does selegiline offer neuroprotection; 2) what is the best agent with which to initiate symptomatic treatment in de novo PD; and 3) is there a benefit of sustained release levodopa over immediate-release levodopa? Using evidence-based principles, a literature review using MEDLINE, EMBASE, and the Cochrane Library was performed to identify all human trials in de novo PD between 1966 and 1999. Only articles that fulfilled class I or class II evidence were included. Based on this review, the authors conclude: 1) Selegiline has very mild symptomatic benefit (level A, class II evidence) with no evidence for neuroprotective benefit (level U, class II evidence). 2) For PD patients requiring initiation of symptomatic therapy, either levodopa or a DA can be used (level A, class I and class II evidence). Levodopa provides superior motor benefit but is associated with a higher risk of dyskinesia. 3) No evidence was found that initiating treatment with sustained-release levodopa provides an advantage over immediate-release levodopa (level B, class II evidence).
This article has been cited by other articles:
|
|
 |
|
  E. B. Montgomery Jr, W. J. Weiner, and S. G. Reich AGONIST OR LEVODOPA FOR PARKINSON DISEASE? ULTIMATELY, IT DOESN'T MATTER; NEITHER IS GOOD ENOUGH Neurology, June 16, 2009; 72(24): 2137 - 2138. [Full Text] [PDF]
|
|
|
|
|
|
C. W. Olanow, M. B. Stern, and K. Sethi The scientific and clinical basis for the treatment of Parkinson disease (2009) Neurology, May 26, 2009; 72(21_Supplement_4): S1 - S136. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. A. LeWitt Levodopa for the Treatment of Parkinson's Disease N. Engl. J. Med., December 4, 2008; 359(23): 2468 - 2476. [Full Text] [PDF]
|
|
|
|
|
|
W. J. Weiner and S. G. Reich Agonist or levodopa for Parkinson disease?: Ultimately, it doesn't matter; neither is good enough Neurology, August 12, 2008; 71(7): 470 - 471. [Full Text] [PDF]
|
|
|
|
|
|
R. Katzenschlager, J. Head, A. Schrag, Y. Ben-Shlomo, A. Evans, A. J. Lees, and On behalf of the Parkinson's Disease Research Grou Fourteen-year final report of the randomized PDRG-UK trial comparing three initial treatments in PD Neurology, August 12, 2008; 71(7): 474 - 480. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Marras and A. Lang Invited Article: Changing concepts in Parkinson disease: Moving beyond the Decade of the Brain Neurology, May 20, 2008; 70(21): 1996 - 2003. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. K Cooper, D. G Brock, and C. M McDaniel Interaction Between Levodopa and Enteral Nutrition Ann. Pharmacother., March 1, 2008; 42(3): 439 - 442. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
W. Simonson, R. A Hauser, and A. H. Schapira Role of the Pharmacist in the Effective Management of Wearing-Off in Parkinson's Disease Ann. Pharmacother., November 1, 2007; 41(11): 1842 - 1849. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C E Clarke Parkinson's disease BMJ, September 1, 2007; 335(7617): 441 - 445. [Full Text] [PDF]
|
|
|
|
 |
|
 L. H.P. Eggermont and E. J.A. Scherder Physical activity and behaviour in dementia: A review of the literature and implications for psychosocial intervention in primary care Dementia, August 1, 2006; 5(3): 411 - 428. [Abstract] [PDF]
|
|
|
|
 |
|
 D. M. Huse, J. Castelli-Haley, L. S. Orsini, G. Lenhart, and J. A. Abdalla Patterns of initial pharmacotherapy for Parkinson's disease in the United States. J Geriatr Psychiatry Neurol, June 1, 2006; 19(2): 91 - 97. [Abstract] [PDF]
|
|
|
|
|
|
O. Suchowersky, G. Gronseth, J. Perlmutter, S. Reich, T. Zesiewicz, and W. J. Weiner Practice Parameter: neuroprotective strategies and alternative therapies for Parkinson disease (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology, April 11, 2006; 66(7): 976 - 982. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. G. Nutt and G. F. Wooten Diagnosis and Initial Management of Parkinson's Disease N. Engl. J. Med., September 8, 2005; 353(10): 1021 - 1027. [Full Text] [PDF]
|
|
|
|
|
|
R. Kurlan "Levodopa phobia": A new iatrogenic cause of disability in Parkinson disease Neurology, March 8, 2005; 64(5): 923 - 924. [Full Text] [PDF]
|
|
|
|
 |
|
 W. J. Weiner Initial Treatment of Parkinson Disease: Levodopa or Dopamine Agonists Arch Neurol, December 1, 2004; 61(12): 1966 - 1969. [Full Text] [PDF]
|
|
|
|
|
|
E. S. Roach Initial Parkinson Disease Therapy: Levodopa, Dopamine Agonists, or Both? Arch Neurol, December 1, 2004; 61(12): 1972 - 1973. [Full Text] [PDF]
|
|
|
|
 |
|
 K. Noyes, A. W. Dick, R. G. Holloway, and Parkinson Study Group Pramipexole v. Levodopa as Initial Treatment for Parkinson's Disease: A Randomized Clinical-Economic Trial Med Decis Making, October 1, 2004; 24(5): 472 - 485. [Abstract] [PDF]
|
|
|
|
|
|
F. Stocchi and C. W. Olanow Continuous dopaminergic stimulation in early and advanced Parkinson's disease Neurology, January 13, 2004; 62(90011): S56 - 63. [Abstract] [Full Text]
|
|
|
|
|
|
A.H. V. Schapira Disease-modifying strategies and challenges in PD: Interactive breakout sessions Neurology, September 23, 2003; 61(90063): S56 - 63. [Full Text]
|
|
|
|
|
|
J. E. Ahlskog Slowing Parkinson's disease progression: Recent dopamine agonist trials Neurology, February 11, 2003; 60(3): 381 - 389. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. L. Albin and K. A. Frey Initial agonist treatment of Parkinson disease: A critique Neurology, February 11, 2003; 60(3): 390 - 394. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Guttman, S. J. Kish, and Y. Furukawa Current concepts in the diagnosis and management of Parkinson's disease Can. Med. Assoc. J., February 4, 2003; 168(3): 293 - 301. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A J Lees Drugs for Parkinson's disease J. Neurol. Neurosurg. Psychiatry, December 1, 2002; 73(6): 607 - 610. [Full Text] [PDF]
|
|
|
|
|
|
P Navan and P G Bain Long term tolerability of high dose ergoline derived dopamine agonist therapy for the treatment of Parkinson's disease J. Neurol. Neurosurg. Psychiatry, November 1, 2002; 73(5): 602 - 603. [Full Text]
|
|
|
|
|
|
R. Inzelberg, P. Nisipeanu, E. Schechtman, J. M. Miyasaki, W. Martin, O. Suchowersky, W. Weiner, and A. E. Lang Practice parameter: Initiation of treatment for Parkinson's disease: An evidence-based review Neurology, October 22, 2002; 59(8): 1292 - 1292. [Full Text] [PDF]
|
|
|
|
 |
|
 ADDITIONAL ARTICLES ABSTRACTED IN ACP JOURNAL CLUB Evid. Based Med., September 1, 2002; 7(5): 131 - 131. [Full Text] [PDF]
|
|
|
|
|
|
A. Albanese Initial bromocriptine did not change mortality in early, mild Parkinson's disease Evid. Based Med., May 1, 2002; 7(3): 91 - 91. [Full Text] [PDF]
|
|
|
|
 |
|
 D. J. Petro Treatment of systemic lupus erythematosus with bromocriptine Lupus, April 1, 2002; 11(4): 266 - 267. [PDF]
|
|
|
|
|
|
O. Suchowersky, G. Gronseth, J. Perlmutter, S. Reich, T. Zesiewicz, and W. J. Weiner Practice Parameter: neuroprotective strategies and alternative therapies for Parkinson disease (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology, April 11, 2006; 66(7): 976 - 982. [Abstract] [Full Text] [PDF]
|
|
Read all Correspondence
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
