Treatment of early Parkinson's disease

Levodopa is still the most effective therapeutic agent for the treatment of Parkinson's disease (PD). Initially, levodopa provides a stable therapeutic response but, during long-term treatment its beneficial effect declines and a gradually increasing number of patients experience fluctuations in motor response. Therefore, in the management of PD it is important to minimise the risks for the development of motor fluctuations. In this context, recent double-blind long-term studies have confirmed the earlier results, suggesting that it appears advisable to initiate dopaminergic treatment in early PD by initially using a dopamine agonist and by adding levodopa when the benefit is no longer adequate with dopamine agonist alone. Another alternative would be to start with selegiline alone, then depending on the disability of the patient, add a dopamine agonist and finally levodopa.