Bromocriptine as initial therapy in elderly parkinsonian patients. The Bromocriptine Multicentre Trial Group

The problems of long-term levodopa treatment are well established, and a number of studies describe the use of bromocriptine as a first-line agent in patients under 65 years. This multicentre double-blind study compared the efficacy of low and very low dose bromocriptine in 64 elderly subjects with newly diagnosed Parkinson's disease. Both regimens led to clinical improvement, but there was a high drop-out rate and a high mortality. These difficulties, together with a low recruitment rate, resulted in problems of statistical analysis. There was no significant advantage in using the higher of the two dosage regimens, and we would recommend a maintenance dosage range of 5 mg-15 mg bromocriptine daily. On the basis of this study, however, bromocriptine seems unlikely to replace levodopa as the first-line treatment for Parkinson's disease.