Treatment of Parkinson's disease

Inspite of extensive research the ideal drug therapy for idiopathic Parkinson's disease (PD) and its optimal timing remain uncertain. Levodopa still is the mainstay of therapy for PD. Little evidence exists to incriminate early institution of levodopa therapy in development of motor fluctuations and dyskinesias in PD. These complications are probably a consequence of disease progression, and resultant inability to synthesise and store dopamine, and buffer the variability in dopamine availability. Therefore, withholding levodopa therapy until late stage of the disease is not warranted. Dopa agonists provide only a short-term benefit. The neuroprotective effect of selegeline remains to be established. There is not enough evidence to justify the current practice of initiating treatment for PD patients with expensive polypharmacy. Research into the development of inexpensive levodopa containing preparations needs to be encouraged.