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Should Levodopa Therapy for Parkinsonism be Started Early or Late? Evidence Against Early Treatment

Published online by Cambridge University Press:  18 September 2015

Stanley Fahn  and
Susan B. Bressman
Susan B. Bressman
Affiliation:
Department of Neurology, Columbia University, College of Physicians and Surgeons and The Neurological Institute of New York
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Abstract

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We define the meaning of early and late treatments and present arguments opposed to early treatment with levodopa. These are based on the development of complications with long-term Sinemet which include clinical fluctuations, loss of efficacy, and painful dystonic cramps. By delaying the onset of levodopa therapy until the symptoms require this most potent of antiparkinsonian agents, we can delay the onset of these disabling problems. Also, using as low a dosage as possible should reduce the risk of any long-term complication related to accumulative dose.

We also present the serial evaluations of 26 patients followed for as long as 7.5 years before levodopa therapy was initiated. Three scoring scales on these patients are compared. Arguments are presented which suggest that the Columbia University and the ADL scales are superior to the UCLA scale, and more closely approximate the curve of the progressive clinical disability of the disease as assessed by global evaluation. We conclude that the ultimate answer to any clinical debate must come from well-designed, controlled studies to assess the differences between two treatment modalities.

Type
7. Treatment of Parkinson’s Disease
Information
Canadian Journal of Neurological Sciences , Volume 11 , Issue S1: Current Concepts and Controversies in Parkinson’s Disease , February 1984 , pp. 200 - 205
Copyright
Copyright © Canadian Neurological Sciences Federation 1984

References

Barbeau, A (1980) High-level levodopa therapy in severely akinetic. parkinsonian patients: twelve years later. In Rinne, U, Klingler, M and Stamm, B, eds: Parkinson’s Disease: Current Progress, Problems and Management. Amsterdam: Elsevier/North-Holland Biomedical Press, pp. 229–239.Google Scholar
Direnfeld, LK, Feldman, RG, Alexander, MP, Kelly-Hayes, M (1980) Is L-dopa drug holiday useful? Neurology, 30: 785–788.CrossRefGoogle ScholarPubMed
Duvoisin, RC (1971) The evaluation of extrapyramidal disease. In de Ajuriaguerra, J and Gauthier, G. eds: Monoamines noyaux Gris Centraux et Syndrome de Parkinson. Symposium Bel-Air IV. Geneva, Georg & Cie, pp. 313–325.Google Scholar
Duvoisin, RC, Yahr, MD, Lieberman, J, Antunes, J, and Rhee, S (1972). The striatal foot. Trans. Am. Neurol. Assoc, 97: 267.Google Scholar
Fahn, S (1977) Secondary parkinsonism. In Goldensohn, ES and Appel, SH. eds: Scientific Approaches to Clinical Neurology, Philadelphia, Lea & Febiger, pp. 1159–1189.Google Scholar
Fahn, S (1982) Fluctuations of disability in Parkinson’s disease: pathophysiological aspects. In Marsden, CD and Fahn, S, eds: Movement Disorders. London: Butterworth Scientific, pp. 123–145.Google Scholar
Fahn, S (in press). Methodology of drug trials in Parkinson’s disease. In Capilideo, R, ed: Methodology of Drug Trials in Neurologic Disorders.Google Scholar
Fahn, S, Calne, DB (1978) Considerations in the management of parkinsonism. Neurology, 28: 5–7.CrossRefGoogle ScholarPubMed
Gortvai, P (1963) Deformities of the hands and feet in parkinsonism and their reversibility by operation. J. Neurol. Neurosurg, Psychiat., 26: 33–36.CrossRefGoogle ScholarPubMed
Hunter, KR, Shaw, KM, Laurence, DR, Stern, GM (1973) Sustained levodopa therapy in parkinsonism. Lancet, 2: 929–931.CrossRefGoogle ScholarPubMed
Ilson, J, Fahn, S, Cote, L (1983) Painful dystonic spasms in Parkinson’s disease. In Hassler, RG and Christ, JF, eds: Adv Neurol, 40:395–398.Google Scholar
Jiang, D-H, Reches, A, Wagner, HR, Fahn, S (in press). Biochemical and behavioral evaluation of pergolide as a dopamine agonist in the rat brain. Neuropharmacology.Google Scholar
Lee, T, Seeman, P, Rajput, A, Farley, IJ, Hornykiewicz, O (1978) Receptor basis for dopaminergic supersensitivity in Parkinson’s disease. Nature, 273: 897–900.CrossRefGoogle ScholarPubMed
Lesser, RP, Fahn, S, Snider, SR, Cote, LJ, Isgreen, WP, Barrett, RE (1979) Analysis of the clinical problems in parkinsonism and the complications of long-term levodopa therapy. Neurology, 29: 1253–1260.CrossRefGoogle ScholarPubMed
Ludin, HP, Bass-Verrey, F (1976) Study of deterioration in long-term treatment of parkinsonism with L-dopa plus decarboxylase inhibitor. J. Neural. Transm., 38: 249–258.CrossRefGoogle ScholarPubMed
Markham, CH, Diamond, SG (1981) Evidence to support early levodopa therapy in Parkinson disease. Neurology, 31: 125–131.CrossRefGoogle ScholarPubMed
Marsden, CD, Parkes, JD (1977) Success and problems of long-term levodopa therapy in Parkinson’s disease. Lancet, 1: 345–349.CrossRefGoogle ScholarPubMed
Marsden, CD, Parkes, JD, Quinn, N (1982) Fluctuations of disability in Parkinson’s disease – clinical aspects. In: Movement Disorders. Marsden, CD and Fahn, S, eds: London: Butterworth Scientific, pp. 96–122.Google Scholar
McDowell, FH, Sweet, RD (1976) The “on-off” phenomenon. In Birkmayer, W and Hornykiewicz, O, eds: Advances in Parkinsonism. Basle: Editiones Roche, pp. 603–612.Google Scholar
Melamed, E (1979) Early-morning dystonia: A late side effect of long term levodopa therapy in Parkinson’s disease. Arch. Neurol., 36: 308–310.CrossRefGoogle ScholarPubMed
Reches, A, Wagner, HR, Jackson-Lewis, V, Yablonskaya-Alter, E, Fahn, S (in press). Chronic levodopa or pergolide administration induces subsensitivity of dopamine receptors in the denervated striatum. Neurology.Google Scholar
Rinne, UK, Koskinen, V, Lonnberg, P (1980) Neurotransmitter receptors in the parkinsonian brain. In Rinne, UK, Klingler, M, Stamm, G, eds: Parkinson’s Disease: Current Progress, Problems and Management. Amsterdam: Elsevier/North-Holland Biomedical Press, pp. 93–107.Google Scholar
Schwab, RS, England, AC Jr. (1969) Projection technique for evaluating surgery in Parkinson’s disease. In Gillingham, FJ and Donaldson, MC, eds: Third Symposium on Parkinson’s Disease. Edinburgh, E & S Livingstone, pp. 152–157.Google Scholar
Stewart, P (1898) Paralysis agitans: with an account of a new system. Lancet, 2: 1258–1260.CrossRefGoogle Scholar
Sweet, RD, McDowell, FH (1975) Five years’ treatment of Parkinson’s disease with levodopa. Ann. Int. Med., 83: 456–463.CrossRefGoogle ScholarPubMed
Weiner, WJ, Koller, WC, Perlik, S, Nausieda, PA, Klawans, HL (1980) Drug holiday and management of Parkinson disease. Neurology, 30: 1257–1261.CrossRefGoogle ScholarPubMed
Yahr, MD (1976) Evaluation of long-term therapy in Parkinson’s disease: Mortality and therapeutic efficacy. In: Birkmayer, W and Hornykiewicz, O, eds: Advances in Parkinsonism. Basle: Editiones Roche, pp. 444–455.Google Scholar