Maybe we should start on Levadopa earlier


#1

Hi all,

I've just read the following link and was going to post it in research as it covers a research study.  But, since the conclusion is about what treatment is best, I decided to post it here.

http://www.crn.nihr.ac.uk/news/nihr-health-technology-assessment-programme-and-clinical-research-network-combine-to-improve-patient-care-through-largest-ever-treatment-trial-of-parkinsons-disease/

I have to say that I (and I think my original neurologist) thought that its best to start out on MAOB Inhibitors (such as Rasagiline/Azilect) then on to the dopamine agonists (such as Requip/ropinerol) staying off levadopa (ie Sinemet/Madopar) for as long as possible.

This study appears to contradict that common belief.

Cheers

AndrewJohn


#2

Over the last few years there have been several articles that threw doubt on the assumption that the appearance of dyskinesias could be delayed, if the PD patient  avoided as long as possible the levodopa drugs. As dyskinesias were particularly bad among the younger patient group after years of treatment (the older patient often died before they appeared) the general rule was to start the under 70 (some choose the over 60s)  PD patient on a Dopamine Agonist and the over 70s on levodopa.  This was the case when I was diagnosed age 55 in 1999. Another reason for this was that older people were more sensitive to certain side effects of the DAs. So there has been a  split among consultants, some prefering either DAs others levodopa as the drug to start on. Many patients (see this forum) have been reluctant  and afraid to start on levodopa , because of one difficult to treat side effect in particular : the dreaded dyskinesias. 

Azilect (and to a lesser degree Selegiline) is often prescribed in the hope that it is neuroprotective,, however, there is no  proof of this as yet, but just in case......