Drug selection and timing of initiation of treatment in early Parkinson's disease

Annals of Neurology
Anthony H V Schapira, C Warren Olanow

Abstract

There is increasing evidence to challenge the traditional view that the initiation of drug treatment in Parkinson's disease (PD) should be delayed until the patient has significant disability such as to affect work or social function. Firstly, to delay treatment sentences the patient to protracted impairment of quality of life that could be improved by therapy. Secondly, there is evidence to support the notion that earlier rather than later initiation of treatment leads to better long term motor benefit. The selection of which drug to begin must be tailored to the patient's individual characteristics and circumstances. Monoamine oxidase B inhibitors result in a mild improvement in motor function compared to dopamine agonists or levodopa. They are well tolerated, easy to use once a day drugs and there is evidence that early use of Rasagiline improves motor outcome. Dopamine agonists lead to a substantial improvement in motor function and are, or will shortly be, available as once a day drugs. They are generally well tolerated but can be associated with exacerbating confusion or hallucinations and with behavioral changes. Levodopa is the most potent of the dopaminergic drugs. It is routinely combined with a dopa decarboxylase inh...Continue Reading

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Citations

Aug 27, 2010·Acta Neuropathologica·Alipi V NaydenovChristine Konradi
Sep 13, 2012·European Journal of Neurology : the Official Journal of the European Federation of Neurological Societies·A H V SchapiraUNKNOWN Study 017 Investigators
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Aug 12, 2014·Molecular Neurobiology·Wooyoung JangSeong-Ho Koh
Aug 21, 2014·Journal of Physical Therapy Science·Hyeong-Dong KimJi Hoon Jeong
May 3, 2019·Clinical Neuropharmacology·Yoshikuni MizunoNobuo Yanagisawa
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Jan 13, 2019·Journal of Neural Transmission·Nobutaka HattoriRyosuke Takahashi

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