[Long-term selegiline tolerance in the treatment of Parkinson's disease]

Tolerability is one of the main problems of the long-term use of antiparkinsonian drugs, especially in the advanced stages of Parkinson's disease. Since 1988, we have performed a prospective study to assess the clinical and therapeutic factors which may influence the tolerability of a new antiparkinsonian drug, selegiline. 168 patients, with a mean age of 68, were treated with selegiline in combination with L-Dopa or with L-Dopa and a dopamine agonist (bromocriptine, lisuride or piribedil). After an average of 19 months, 23 adverse effects (13.7%) were noted during the first three months of treatment with selegiline. Discontinuation was required in only 10 cases (5.9%) with 9 out of 10 for a psychotic episode. Neither age, nor the stage of the disease, nor the dose of levodopa in combination with selegiline or the presence of mental disturbances seemed to be predicting factors for appearance of a psychic episode. If selegiline with levodopa or with bromocriptine and levodopa appeared to be safe antiparkinsonian combinations, significant psychic side effects occurred with piribedil in combinations with selegiline and levodopa. A possible explanation was that selegiline potentiates piribedil side-effects.