Parkinson's disease: new treatment strategies

Recent interest has focused on two novel approaches to the treatment of Parkinson's disease-medications to slow or arrest disease progression, and cerebral transplantation. Two recent studies have demonstrated that selegiline can slow, although not halt, the progression of recent-onset Parkinson's disease. The data are sufficiently compelling to justify the use of this drug in most new patients. It also seems reasonable to extrapolate from the data and offer this medication to all patients but those with the most advanced Parkinson's disease. The current focus on excessive oxidative stress as a causative factor has led some investigators to recommended treating patients with the antioxidant tocopherol (vitamin E). There is no clinical evidence demonstrating its effectiveness, but a current multicenter study is being conducted, with the results expected within the next 2 years. High-dose vitamin E (such as 800 to 2000 U/d), taken for a number of months, is probably harmless. It is probably reasonable, therefore, to allow patients to take this over-the-counter compound until more definitive evidence is available. Another antioxidant, vitamin C, has also been advocated as a means of slowing the progression of Parkinson's disease. There are no studies that demonstrate any clinical effectiveness, and there are also no ongoing studies investigating this issue in patients with Parkinson's disease. The excitement surrounding the initially favorable results of adrenal-brain transplantation has waned with the failure of numerous institutions to replicate the original dramatic success. While mild or occasionally moderate improvement has been noted in subsequent patients undergoing adrenal-brain transplantation, the improvement has not been sufficient to justify the risk and expense of this surgery.(ABSTRACT TRUNCATED AT 250 WORDS)