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From the Department of Neurology, Mayo Clinic, Rochester, MN.
Address correspondence and reprint requests to Dr. J. Eric Ahlskog, Dept. of Neurology, Mayo Clinic, Rochester, MN 55905; e-mail: eahlskog{at}mayo.edu
In recent clinical trials, chronic treatment of patients with PD with pramipexole or ropinirole was associated with a slower decline of imaged striatal dopaminergic signal, compared to levodopa monotherapy. Although this could reflect slowed progression of PD, equally plausible is a pharmacologic effect on proteins that interact with the imaging radioligands. To date, there is no compelling evidence favoring dopamine agonists over levodopa; either is an appropriate choice for initial treatment of PD.
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