After more than a decade levodopa (combined with a peripheral decarboxylase inhibitor) remains the standard treatment for Parkinson’s disease (PD) with up to 90% of patients responding. However, levodopa does not halt the advance of the underlying disease, but by improving mobility, it delays the onset of fatal complications (Marsden and Parkes, 1977; Yahr et al., 1972). Thus, after 2–5 years many PD patients have increased disability. The increased disability may manifest itself by the reappearance of old symptoms, i.e., symptoms present before levodopa treatment, or by new symptoms, symptoms not present before levodopa treatment. Most of the new symptoms are disease manifestations seen only because patients live longer (postural instability, dementia), and some of the symptoms may result from the chronic effects of levodopa itself (dyskinesias, diurnal oscillations in performance).
KeywordsParkinson Disease Ergot Alkaloid Levodopa Treatment Parkinsonian Symptom Decarboxylase Inhibitor
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- Bernheimer, H., Birkmayer, W., Hornykiewicz, O., Jellinger, K., and Seitelberger, F., 1973, Brain dopamine and the syndromes of Parkinson and Huntington. Clinical, morphological and neurochemical correlations, J. Neurol. Sci. 20: 415–455.Google Scholar
- Hefti, F., Melamed, E., and Wurtman, R J, 1980, Partial lesions of the dopaminergic nigrostriatal system in rat brain: Biochemical characterization, Brain Res. 195: 123–137.Google Scholar
- Lieberman, A. N., Goodgold, A. L., and Goldstein, M., 1973, Treatment failures with levodopa in parkinsonism, Neurology22: 1205–1210.Google Scholar
- Lieberman, A.N., Gopinathan, G., Estey, E., Kupersmith, M., Goodgold, A., and Goldstein, M., 1979b, Lergotrile in Parkinson disease: Further studies, Neurology29: 267–272.Google Scholar
- Lieberman, A. N., Dziatelowski, M., Gopinathan, G., Kupersmith, M., Neophytides, A., and Konein, J., 1980a, The evaluation of Parkinson’s disease, in: Advances in Biochemical Psychopharmacology, Vol. 23 ( D. Caine, M. Goldstein, A. Lieberman, and M. Thorner, eds.), pp. 227–286, Raven Press, New York.Google Scholar
- Lieberman, A. N., Kupersmith, M., and Neophytides, A., 1980b, Bromocriptine in Parkinson’s disease: Report on 106 patients treated for up to 5 years, in: Ergot Compounds and Brain Function: Neuroendocrine and Neuropsychiatric Aspects( D. Caine, M. Goldstein, A. Lieberman, and M. Thorner, eds.), pp. 245–253, Raven Press, New York.Google Scholar
- Lieberman, A., Goldstein, M., Leibowitz, M., Neophytides, A., Kupersmith, M., Pact, V., and Kleinberg, D., 11981, Treatment of advanced Parkinson disease with pergolide, Neurology31: 675–682.Google Scholar
- Lieberman, A. N., Neophytides, A. N., Leibowitz, M., Gopinathan, G., Pact, V., Walker, R., Goodgold, A., and Goldstein, M., The comparative efficacy of pergolide and bromocriptine in patients with Parkinson disease, 1983c, in: Experimental Therapeutics of Movement Disorders, Vol. 37 (S. Fahn, D. B. Caine, and I. Shoulson, eds.), pp. 95–108, Raven Press, New York.Google Scholar
- Lieberman, A. N., Gopinathan, G., and Neophytides, A., 1984a, The antiparkinsonian efficacy of deprenyl: A specific type “B” monoamine oxidase inhibitor, NY State J. Med. 84: 13–16.Google Scholar
- Rinne, U. K., and Mölsä, P., 1979, Levodopa with benserazide or carbidopa in, Parkinson disease, Neurology29: 1584–1589.Google Scholar
- Ungerstedt, U., 1971, Postsynaptic supersensitivity after 6-hydroxydopamine induced degeneration of the nigro-striatal dopamine system, Acta Physiol. Scandinavia., 367 (Suppl.): 69–93.Google Scholar
- Yahr, M. D., Wolf, A., and Antuner, J., 1972, Autopsy findings in parkinsonism following treatment with levodopa, Neurology22 (Suppl.): 56–71.Google Scholar