[Difficulties and errors in ambulatory therapy of Parkinson disease]

The clinical findings as well as the follow-up of 52 patients with progressive Parkinsonism were analyzed and the following results obtained: The reasons for the clinical progression of the disease were most often acute secondary illnesses not involving the CNS, Parkinsonism-independent CNS lesions ("Parkinson plus"), the absolute as well as relative L-DOPA overdose and, lastly but significantly, the effects and side-effects of too many prescribed drugs. Our findings resulted in the following therapeutic recommendations: A monotherapy should be used for as long as possible with slowly increasing doses up to the threshold of tolerance. Only if necessary should alternative drugs or a combination of not more than two drugs be used. Parkinsonism progresses even with the present best therapy. So far, it was only been possible to mitigate this progress, but not to prevent it. In the late stage of the disease it is more appropriate to accept some remaining symptoms than to risk an overdose or polypharmacy with its attendant problems.