[Initiation of treatment in Parkinson disease]

Initiating treatment in a patient with Parkinson's disease requires consideration of age, degree of disease activity, and consequences of long-term treatment. In young patients, albeit dopaminergic agonists or selegiline are possible alternatives, they will never be as effective as L-dopa, and they can be used only initially in very mild cases and for a short period of time. Long-acting L-dopa is probably better after titration with standard preparations. Potential neuroprotection by selegiline has not been confirmed so far, but it acts as a mild anti-Parkinsonian. In patients over 60, it is recommended not to use anticholinergic or dopaminergic agonists, but to start with a low dose of L-dopa and increase it by a maximum of 125 mg every 7 to 10 days. Clozapine can be very useful against psychosis.